what to do when a first trimester emergency happens

Early pregnancy is a particularly anxiety provoking time in one’s life.  For one, your life changes with the positive pregnancy test. You start imagining life with this child. You mentally decorate the nursery and fill the closet with the cutest baby clothes.  You budget schools and weddings etc. All this just based on a urine pregnancy test! We all do it (and we all take at least 3 pregnancy test… admit it!!). Early pregnancy is also nerve-racking because for many families this was not an easy point to get to (at least 15% of women have some fertility difficulty), or you have had a miscarriage (or several) in the past.  And lastly, there is the lack of control that we all have over what goes on in early pregnancy. These pregnancies advance or they don’t for a variety of reasons outside of any person’s control… and in today’s society, we all want immediate gratifying control of everything.

3 facts about the first trimester of pregnancy

So as you can imagine, situations arise that make you wonder if you should call the doctor’s office or not… especially the after hours emergency line.  Let me start off by introducing a few important statistics:

  • First trimester miscarriage rates are 15-20% (This is of recognized pregnancies.  There are studies done where women get pregnancy tests done daily and around 25-30% of these women go from a positive test to a negative test before the pregnancy is even clinically verified.)
  • Even heavy, prolonged bleeding can be associated with a normal outcome.  Only 12% of women with first trimester vaginal bleeding have a miscarriage (miscarriage also occurred in 13% of women without bleeding).
  • In over 90% of pregnancies in which vaginal bleeding occurs at 7-11 weeks and a fetal heartbeat is detected, pregnancy continues.

To summarize, miscarriage is common (unfortunately) and cannot always be predictable by bleeding.  In addition, there just is not any intervention that can sway the pendulum from miscarriage to continued pregnancy or vice versa.  

I want to preface the next part of this discussion by saying that calling the office is always OK.  We are there for you. During office hours our triage nurses, along with advice from the providers, can help decide on expedited or same day appointments, labs that need to be done, or just reassurance over the phone.  But there are situations where there is NOT a need to go to the ER or call the emergency line at 3am.

What are the true pregnancy emergencies that 100% warrant a call whenever or an ER visit?

Hemorrhage

So what exactly is qualified as hemorrhaging?  Well sometimes it is obvious.  I generally tell people that if you are fully saturating the thickest pad more than once an hour for 3 hours in a row then we should hear from you.  

Severe Pain

This is especially important if we have not yet done a sonogram for the pregnancy to verify that it is in the uterus.  If you have very severe unrelenting pain and have not had proof of an intrauterine pregnancy, there is a chance it is an ectopic pregnancy (one that is outside of the uterus, most commonly in the fallopian tube).

Severe nausea and vomiting

I consider severe if you have 4-6hr of being unable to tolerate liquids.  This is usually accompanied by little to no urine output due to severe dehydration.  We can often call in prescription nausea meds or help you decide if coming to the emergency room is warranted.

What are first trimester issues that can generally wait until the next business day?

  • Bleeding lighter than the above:  Remember the aforementioned statistics about how common bleeding can be in normal pregnancy.  Remember, no one can control or intervene to control the outcome of early pregnancy. Lastly, even if you know you are Rh-negative blood type, as long as you have already had Rhogam or get it within 3 days of bleeding, then you are fine.  
  • Cramping: There can be cramping in pregnancy that is normal.  If not severe pain it can most likely wait until the next business day.  Often it may resolve by then anyways.
  • Mild nausea and vomiting: (Please see above for severe.) 
  • Fever: Most fevers are not pregnancy related and are usually due to another illness (upper respiratory infection like flu, GI bug etc).  If it is in the middle of the night, try Tylenol (acetaminophen), and if not better in the AM, please call us and we will figure out the best course of action.  If Tylenol does not help at all and you are "deathly" ill you should use your judgement and go to the ER if you think it is necessary.  But in that situation feel free to call us first.
  • Discharge:  First trimester discharge concerns can almost always wait for business hours or at least during the daytime if on a weekend.
  • Medication questions:  Our website has a link to some of the many over-the-counter medications that are OK for pregnancy.  If you are on prescription medications that you need to take those questions can most certainly wait until the next business day. 
  • Basic activity questions (Can I do this?, Can I do that?, Can I go here?, Can I go there?, can i eat this?, can I eat that?) can wait for business hours.  Often these are appropriate questions that "Dr. Google" can help with (but be careful of "Dr. Google"!!). There is also good information in our FAQ portion of the website and in past obstetrics blogs.

I hope this helps answer some of the “what if” questions for the first trimester.  I will write a blog about the 2nd and 3rd trimesters in the future.

Dr. Bernstien