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Episode 3 – ACEP 2012 Management of Early Pregnancy

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The original ACEP guidelines can be found here.

This table from (Annals of Emergency Medicine  Volume 58, Issue 1, July 2011, Pages 12–20) shows the IUPs eventually discovered on f/u vs. what was seen in the ED at various thresholds of bHCGs.

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Now on to the Podcast:

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Scott Weingart

An ED Intensivist from NY.

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2 Comments on "Episode 3 – ACEP 2012 Management of Early Pregnancy"

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SamG
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SamG
Scott- agree with all you said in this podcast.. I think the major problem with the use of a single discriminatory zone, lies largely in the definition of IUP. These old studies with 1500-2000 endocavitary, and 6000-6500 for trans-abdominal, are all based on the definition of IUP being a gestational sac. With our current definition of at least seeing yolk sac to call it IUP (due to pseudogesational sacs), I don’t think those old numbers for discriminatory zone even apply anymore whatsoever: When we’re talking about discriminatory zone for Yolk Sac, the numbers, as expected, much higher: Here’s a study showing this– check out the numbers: http://www.ncbi.nlm.nih.gov/pubmed/23262929 I don’t understand why everyone keeps pretending that this zone is even at all applicable anymore when they were based on gestational sac, and we’re looking for yolk sac. I think this is the study you referred to in the audio- when you factor in Emergency Physicians performing the ultrasound, and the disparity in ultrasound equipment, etc…now the discriminatory zone is even that much more, way, ridiculously off: http://emupdates.com/perm/Wang%20Discriminatory%20Zone%202011%20AnnEM.pdf What ends up happening is OB gets consulted on a ton of stable patients, with no evidence of ectopic on ultrasound bc of a… Read more »
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3 years 6 months ago
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Episode 9 – Pregnancy Emergencies | FOAMcast

[…] review Dr. Scott Weingart’s Practical Evidence Podcast #3 – ACEP 2012 Management of Early Pregnancy, in which he summaries the ACEP 2012 Clinical Policy on this […]

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Scott Weingart, MDHi, my name is Scott Weingart.
I am an ED Intensivist from New York. Along with my friends, we are attempting to provide and teach Maximally Aggressive Care, Everywhere! From the field to the ICU, EMCrit is about optimal critical care and resuscitation.

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