First-Trimester Vaginal Bleeding: Patient Expectations When Presenting to the Emergency Department.

ABSTRACT

OBJECTIVE: First-trimester vaginal bleeding is a common presenting complaint to the emergency department (ED). Many studies have looked at risk factors, evaluation, and treatment, but none have looked at the motivating factors for seeking care. The objective was to identify the most commonly held concerns by women experiencing first-trimester vaginal bleeding. METHODS: A questionnaire was distributed to pregnant patients as they checked into the ED from January to July of 2013 with concern for first-trimester vaginal bleeding. Patients were instructed to rank a prepopulated list of reasons motivating their visit on the basis of level of importance. The study was given expedited approval by the Office of the Institutional Review Board. RESULTS: The most common reason behind a visit for vaginal bleeding in the first trimester was to have an ultrasound and blood work performed to evaluate the well-being of their fetus (41.8% [95% confidence interval (CI) 34-50.1%]). The second most common reason, with a rate of 34% (CI 26.7-42.2%), was to simply know whether or not the patient was having a miscarriage, with no specific method of evaluation mentioned. A minority of patients ranked the potentially emergent conditions such as ectopic (3.5%), life-threatening hemorrhage (4.3%), or otherwise abnormal pregnancy (2.1%) as being their chief concern. CONCLUSIONS: First-trimester vaginal bleeding is a commonly encountered complaint in ED. Results obtained in this study reveal the largest proportion of patients surveyed expected an ultrasound and blood work and wanted to know by the end of the visit if she was having a miscarriage. This information gained from this study may be helpful to the emergency physician in managing expectations, catering to the patient's concerns, and may also be useful in boosting patient satisfaction.