11-07-2014, 09:53 AM
A 40-year-old G3P0 woman presents to the emergency department with complaints of scant vaginal bleeding. She is 9 weeks' pregnant based on a crown-rump length measurement at her first obstetric clinic visit 2 weeks ago. She says she woke up this morning with vaginal spotting and mild abdominal cramping. Transvaginal ultrasound performed at the bedside demonstrates a fetal pole measuring 7 weeks with no detectable heartbeat. On speculum examination there is scant blood in the vaginal vault and the cervix is open. Blood is drawn to screen for Rho(D) antibodies.
What is the most appropriate next step in management?
A. Administer Rho(D) immune globulin if the mother is Rh negative, then administer methotrexate
B. Administer Rho(D) immune globulin if the mother is Rh negative, then admit the patient for emergent curettage
C. Administer Rho(D) immune globulin if the mother is Rh negative, then discharge her home with follow-up instructions to return if the bleeding or pain increases in severity
D. Administer Rho(D) immune globulin, then admit the patient for emergent curettage
E. Administer Rho(D) immune globulin, then discharge her home with instructions to return if the bleeding or pain increases in severity
What is the most appropriate next step in management?
A. Administer Rho(D) immune globulin if the mother is Rh negative, then administer methotrexate
B. Administer Rho(D) immune globulin if the mother is Rh negative, then admit the patient for emergent curettage
C. Administer Rho(D) immune globulin if the mother is Rh negative, then discharge her home with follow-up instructions to return if the bleeding or pain increases in severity
D. Administer Rho(D) immune globulin, then admit the patient for emergent curettage
E. Administer Rho(D) immune globulin, then discharge her home with instructions to return if the bleeding or pain increases in severity