1. First Trimester Bleeding
This presentation is designed to be interactive. You will start by passing out a short pre-test which seeks to activate learners and help them focus on the key points of the presentation. Give learners approximately 5 minutes to complete the test. Next, you will divide participants into small groups and pass out the cases and algorithm. Allow each group to discuss the cases in a small group prior to reuniting in a big group to review. The cases are included below along with the answers (in italics) for each section. PowerPoint will be used to display images during the large group discussion where noted below. Be sure to refer to the algorithm for each step of the cases. Once you have finished discussing the cases, review the answers to the pre-test for which an answer guide is provided.

2. Maria’s first ultrasound
 Ultrasound shows a gestational sac measuring 7mm and a yolk sac without a fetal pole.

3. Maria’s Second Ultrasound
Repeat U/S shows a gestational sac, yolk sac and fetal pole measuring 4mm with fetal heart tones seen on U/S.

4. Aisha’s Ultrasound
Ultrasound reveals a gestational sac, yolk sac and 15mm CRL with no fetal cardiac activity seen.

5. Anembryonic Pregnancy
Gestational sac measures 22mm with no yolk sac and no fetal pole.

6. Colleen’s Ultrasound
The ultrasound shows no IUP, thickened endometrial stripe, fundal IUD, a 2cm complex adnexal mass and a small amount of fluid in the cul-de-sac. Note, IUD not visible on this image.

7. Jessica’s Ultrasound Fluid
The ultrasound shows no IUP, a small amount of fluid in the cul-de-sac.

10. Reference: Doubilet, Peter M. , et al
Reference: Doubilet, Peter M., et al. "Diagnostic criteria for nonviable pregnancy early in the first trimester." New England Journal of Medicine  (2013):

11. Updated 7/2017