Welcome to Emergency Medicine Cases.com. I'm your host, Dr. Anton Hellman, bringing you Canada's

brightest minds in emergency medicine from EMC Studios in Toronto.

On this month's episode number 23 on vaginal bleeding in early pregnancy we have with us Dr. David

Dushensky and Dr. Ross Claibault. Dr. Dushensky is an emergency physician at Mount

Sinai Hospital in Toronto where he's the deputy director and quality assurance

coordinator. He's a lecturer at the University of Toronto and has won multiple

postgraduate teaching awards. Dr. Ross Claibault is an emergency physician at North York

General, Sunnybrook, and Markham-Stowville hospitals. He graduated from the University of Toronto

Emergency Medicine Training Program in 1985 and his work in the Middle East. He's a lecturer at the

University of Toronto and is active in undergraduate and resident training. Vaginal bleeding in early pregnancy

is oh so common. 30% of pregnant women experience vaginal bleeding at some point during their

pregnancy, most of which occurs in the first half of pregnancy. And in some centers, like the one

that I work in, in North York General, we see these patients in the ED on pretty much every shift

we do. The majority of these

patients don't need much beyond a beta HCG, blood type, bedside ultrasound, and some counseling and

follow-up. But there is a significant minority that will have an ectopic pregnancy or a serious

complication of a miscarriage, both of which still contribute to maternal mortality. We're going to

limit our discussion in this episode to vaginal bleeding in the first half of pregnancy because in most

hospitals, pregnant patients who are more than 20 weeks gestational age go directly to the obstetrics

unit, and so we almost never see things like placenta previa and abruption, which typically present in the second half of pregnancy.

So with the help of Dr. David Dushensky, who works at one of Canada's biggest tertiary care obstetric centers, Mount Sinai Hospital,

where they see bigillions of pregnant patients in the ED, and Dr. Ross Claibault, who's got more than 30 years of clinical experience

...