The Clinical Problem Solvers Episode 421: Baby on Board – and a surprise guest! Listen to Greg and Bobby discuss how to manage the guest tagging along for the ride!!
Sep 18, 2025
Greg Kirshen, a maternal-fetal medicine specialist, and Bobby Brar, a fellow in maternal-fetal medicine and clinical genetics, join Anna Jarvis, an OB/GYN resident, to discuss a complex case involving a 10-week pregnant woman with severe abdominal pain and large-volume ascites. They explore differential diagnoses, including infection and malignancy, and share insights on management strategies. The conversation emphasizes the importance of a broad differential and offers practical counseling for future pregnancies.
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Broad Differential For Early Pregnancy Ascites
- Large-volume ascites in early pregnancy is an uncommon and alarming finding that demands broad thinking across obstetric and non-obstetric causes.
- Consider GI, GU, infectious, malignant, and pregnancy-specific etiologies rather than assuming a single system is responsible.
Always Confirm Intrauterine Pregnancy
- Confirm whether a suspected intrauterine pregnancy is truly intrauterine to avoid missing an ectopic.
- Use detailed ultrasound evaluation and consider ectopic locations (e.g., corneal) when imaging or clinical findings are atypical.
Paracentesis Labs Guide Next Steps
- Use serum-ascites albumin gradient (SAAG) and total protein to narrow ascites causes: SAAG <1.1 points away from portal hypertension.
- Send ascites fluid for extended cultures including TB and cytology when initial workup is unrevealing.
