This case scenario is appropriate foremergency medicine residents of all levels and senior medical students.
There are approximately 1 million abortions performed in the United States each year.1,2 Roughly 3% of all women will have an abortion in their lifetime.3 Therapeutic abortions can be induced medically with several medications or via dilation and curettage or dilation and evacuation. Since the legalization of abortion in 1973 the overall morbidity and mortality of abortions has dramatically declined and is now deemed to be a relatively safe procedure.4 Reports show minor complications occurring in 8 of every 1000 legal abortions, major complication at a rate of 0.7 per 1000 and mortality occurring in 0.7 per 100,000 legal abortions each year.4 Infection and hemorrhage are the most common causes of abortion related mortality, with hemorrhage accounting for approximately 14% of all first trimester abortions complications and 33% to 40%of all second trimester abortions.4
By the end of this simulation, participants will be able to: 1) recognize post-termination hemorrhage and hemorrhagic shock; 2) demonstrate appropriate acute resuscitation for a patient with hemorrhagic shock; 3) review the differential diagnosis for a patient with post-termination hemorrhage; 4) identify the indications for massive transfusion protocol.
This is a high-fidelity simulation, followed by a debriefing session. However, it could be adjusted for low- or moderate-fidelity simulation, or for an oral board case.
This simulation was piloted with 15 emergency medicine residents who provided verbal feedback and evaluation of the session.
The reception was positive with learners appreciating the learning points of this important but rare presentation. However, they requested future simulations attempt a more realistic representation of the vaginal bleeding presentation.
Overall, this simulation is an effective method of introducing important concepts in the evaluation and management of a patient with post-termination hemorrhage and allows for assessment of learners in the acute resuscitation of these patients.
Post-termination hemorrhage, retained products of conception, syncope, obstetrics and gynecology, Ob/gyn.