Hall John W, Denne Nicolas, Minardi Joseph J, Williams Debra, Balcik B J
West Virginia University School of Medicine, Department of Emergency Medicine, Morgantown, West Virginia.
West J Emerg Med. 2016 Jul;17(4):460-3. doi: 10.5811/westjem.2016.5.30326. Epub 2016 Jul 5.
Early pregnancy complaints in emergency medicine are common. Emergency physicians (EP) increasingly employ ultrasound (US) in the evaluation of these complaints. As a result, it is likely that rare and important diagnoses will be encountered. We report a case of fetal anencephaly diagnosed by bedside emergency US in a patient presenting with first-trimester vaginal bleeding.
A 33-year-old patient at 10 weeks gestation presented with vaginal bleeding. After initial history and physical examination, a bedside US was performed. The EP noted the abnormal appearance of the fetal cranium and anencephaly was suspected. This finding was confirmed by a consultative high-resolution fetal US. Making the diagnosis at the point of care allowed earlier detection and more comprehensive maternal counseling about pregnancy options. This particular patient underwent elective abortion which was able to be performed at an earlier gestation, thus decreasing maternal risk. If this diagnosis would not have been recognized by the EP at the point of care, it may not have been diagnosed until the second trimester, and lower-risk maternal options would not have been available.
急诊医学中早孕相关主诉很常见。急诊医生（EP）越来越多地使用超声（US）来评估这些主诉。因此，很可能会遇到罕见且重要的诊断情况。我们报告一例在孕早期出现阴道出血的患者，通过床边急诊超声诊断为胎儿无脑畸形的病例。
一名妊娠10周的33岁患者出现阴道出血。在进行初步病史采集和体格检查后，进行了床边超声检查。急诊医生注意到胎儿颅骨外观异常，怀疑为无脑畸形。这一发现通过会诊高分辨率胎儿超声得以证实。在床边即时诊断使得能够更早地发现，并为孕妇提供关于妊娠选择的更全面咨询。该特定患者接受了选择性流产，且能够在更早的孕周进行，从而降低了产妇风险。如果急诊医生在床边即时未识别出该诊断，可能要到孕中期才会诊断出来，且产妇将无法选择风险较低的方案。
