10/27/2025
1. Order a same-day STAT OB transvaginal ultrasound
2. Look for gestational dating, confirmation that the pregnancy is IN the uterus, and that a heartbeat is present (almost always present by 6 weeks at the latest). Note any evidence of fluid, bleeding or placental detachment.
3. Order labs: HCG and progesterone. When the results come back, compare the reference ranges to how many weeks pregnant your patient is. Are they at least in the middle of the range? Fax all US and lab results to their new OB ASAP
4. Miscarriage is a normal part of the eliminatory function of the uterus in very early pregnancy. Most of the time, early first trimester miscarriage occurs because the body notes a problem and expels the contents of the uterus. Despite what our culture tells us, this is normal and necessary. 99% of the time, pregnant persons can miscarry safely at home.
5. However, any of the following should prompt an ED visit: excessive bleeding or pain, intense unilateral cramping in the pelvis which can indicate ectopic pregnancy, dizziness, lightheadedness, rapid HR of change in cognition/ level of consciousness.
And there you have it. Most of the time, pregnant folks just want reassurance and not to have to go through a possible miscarriage alone, without a medical provider in their corner. PCPs: join there team, hold their hand, support them until they can see their new OB. Ok???
It’s not rocket science. Let’s do the right thing 🤘
