Threatened Miscarriage (cont.)

Exams and Tests

Medical history: The doctor or nurse in the emergency department will ask many questions, such as the following:

• How far along is your pregnancy?



• When was your last normal period?



• How many times have you been pregnant?



• How many living children do you have?



• How many miscarriages have you had?



• Have you ever had an ectopic (tubal) pregnancy?



• Were you using any sort of birth control when you got pregnant this time?



• Have you had any prenatal care?



• Have you had an ultrasound yet to show that the pregnancy is in the right place?



• What medical problems do you have?



• What medications do you take every day?



• What herbs or other products do you take every day?

Physical exam: For the pelvic exam, you will lie on your back with your knees bent and your feet in stirrups.

• You may have a speculum exam. A metal or plastic device is put in your vagina and then opened, spreading the walls of your vagina apart so the health care provider can look right at the mouth of your womb. If there is a lot of blood or clots, the provider may use a clamp or gauze to remove it. You should not feel any pain during this part of the exam, although you may be embarrassed and uncomfortable.



• You may have bleeding from the vagina before, during, and even after a miscarriage. The health care provider will assess the opening of the entrance to the womb (called the os) and, depending on the findings, will be able to tell you more accurately which of the stages of miscarriage you might be experiencing. 

• The health care provider may put gloved fingers in your vagina and feel your abdomen with the other hand. He or she can feel whether the mouth of your uterus is open, how big your uterus may be, and whether there are any signs of infection or tubal pregnancy. The size of your uterus may be smaller than expected for the fetus if you have already miscarried.

Lab tests: Pregnancy tests can be either urine tests or blood tests. Your health care provider or emergency department doctor, if you go to the hospital with alarming symptoms, will act quickly to determine if you are pregnant.

• A urine pregnancy test along with blood samples will be sent to the laboratory to check for blood loss or anemia, blood type, and the level of the pregnancy hormone. This hormone is called human chorionic gonadotropin or hCG.
  
  
  • A number too low may suggest that it is an abnormal pregnancy. No single number is "normal." A very low number (under 1,000) suggests an abnormal pregnancy, although it could just be an early pregnancy.
  
  
  
  • A very high number (over 100,000) strongly suggests a normal living pregnancy. Most other numbers by themselves do not help a lot but can be compared to another test done in 2-3 days to see if everything is developing normally.


• A complete blood count may be drawn. If you have been bleeding a lot, you may be anemic (loss of too much blood) and need special care. If you have a fever, your white cell count may suggest you have an infection.



• If you do not know your blood type, this will also be checked. If you are Rh-negative, you will probably receive a special medicine called RhoGAM to protect you and your baby from a bad reaction.



• If you have symptoms of a urinary infection, a urine sample will be taken and examined.

Ultrasound: If you are pregnant, an ultrasound may be performed to look for evidence of a pregnancy within the uterus. If the radiologist, gynecologist, or emergency department doctor cannot find evidence of a pregnancy within the uterus, you will likely be evaluated further for a pregnancy that is outside your uterus. When the fertilized egg implants in the fallopian tube, this is called a tubal or ectopic pregnancy.

• The technician may put some cold jelly on your abdomen for transabdominal ultrasound and press down with a probe to see your internal organs. The ultrasound technician may also use a vaginal probe inside your vagina to get a better look at your tubes and ovaries. Neither of these studies should be painful.

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