What to expect in the emergency department

Note: this is the same information in the video above but in written format. 

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Will there be a long wait?

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When a person goes to the Emergency Department, they are triaged according to the acuity or severity of their illness. Therefore, it is often unpredictable how long it will take for you to be seen by a doctor after you arrive. 

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What will the doctors and nurses do?

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Triage

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The nurse at triage will ask you questions about your symptoms, your current pregnancy, prior pregnancies, and your past medical history. While this is a brief assessment, they are able to determine the severity of your symptoms based on your descriptions. 

 

It is helpful to quantify for the triage nurse how much bleeding you are having and what your symptoms are right now. How many pads have you changed in the last hour? Are you passing large clots (which look like dark jelly)? Are you experiencing pain? Is the pain constant or more like cramping on and off?

 

All of this information is helpful to the care team looking after you. 

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Bloodwork

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If you have not yet had blood work done during this pregnancy, you should expect to have a blood test done to measure the serum pregnancy hormone called beta human chorionic gonadotropin, which is also called “beta-hCG”.  This hormone is the same one that is measured when you do a urine pregnancy test, but the blood test measures the amount in the blood.

 

While a one time test of the beta HCG cannot often determine what is causing your symptoms, this test is used to see how far along you might be in your pregnancy, the likelihood of seeing a pregnancy on the ultrasound, and may be used for monitoring the pregnancy after the emergency department visit. 

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Assessment and Physical Exam

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When you are seen by the emergency medicine doctor, they will ask you your symptoms and history again in order to complete a full assessment. They will also perform a physical exam, which includes examining your abdomen for pain. They may or may not perform a pelvic exam, depending on how much bleeding is taking place. If there is substantial amounts of bleeding, a pelvic exam may be performed with a speculum in the vagina to assess the amount of bleeding and to help remove blood clots from the cervix, which is the entryway to the uterus. Removing these clots decreases the amount of bleeding. 

 

This type of exam does not cause a miscarriage. 

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Ultrasound

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The emergency medicine doctor may perform a bedside (or point of care) ultrasound, which is an ultrasound done in the emergency department. This ultrasound assessment can see if the pregnancy is visible in the uterus or not and if the heartbeat is present or not. This is a preliminary assessment that, depending on what the emergency medicine doctor sees, may be followed by a formal ultrasound performed by a radiology technician which is then reviewed and interpreted by a radiologist. 

 

Waiting for the ultrasound with the radiology technician can take a long time, because they are often completing ultrasounds on patients throughout the hospital and the emergency Department.  Also some emergency departments do not have radiology technicians available outside of office hours or on the weekends.

 

If the emergency medicine doctor thinks it is safe, they may ask that you return the following day or at another scheduled time so that you do not have to wait for a long time in the emergency department. 

 

Ultrasounds are safe and do not cause any harm in pregnancy.

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Risk Assessment

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The emergency medicine doctor wants to ensure that you are not bleeding so heavily that you are in danger. They also want to make sure you are not at risk of a ruptured ectopic pregnancy, which is a pregnancy that is outside of the uterus. An ectopic pregnancy can rupture when it increases in size and can be a life threatening medical emergency if this occurs. 

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So what's going on? What is happening in your body?

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Unfortunately, even with blood work and an ultrasound, the medical team may not be able to tell you what is causing spotting or bleeding and they may not be able to tell you if you are having a miscarriage. 

 

In these situations, which are more common in the first 4 to 8 weeks of pregnancy, you will be asked to either follow-up with your family doctor, an obstetrician/gynaecologist or a dedicated early pregnancy clinic within several days to one week. 

 

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Pregnancy Categories

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After comprehensive assessment, pregnancy will fall into one of the following categories.​ Based on the category, the following symptoms can be expected after an Emergency Department visit:

1. Threatened pregnancy loss

2. Pregnancy of unknown location

3. Ectopic pregnancy

4. Early pregnancy loss, including complete, incomplete, or missed miscarriage

 

This categorization determines the appropriate next steps, management options, and follow-up care to offer. Click the links above to learn more.

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Red Flags? Reasons to return to the emergency department?

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At the end of the Emergency Department visit, the health care provider will give you some instructions, or what we call ‘red flags’ for when to return to the Emergency Department (see below).