Ectopic Pregnancy

All women of childbearing age who present with abdominal pain need a pregnancy testa core teaching of EMergency medicine

Ectopic pregnancy is the leading cause of maternal death in the first trimester

History

* Abdominal pain present in 90% of cases* Amenorrhea present in 70% of cases* Vaginal bleeding present in 50% of cases

The biggest red flag with this complaint is history of receiving fertility treatments (increased risk of heterotopic pregnancy)

Exam

* Abdominal tenderness and peritoneal signs* Adnexal tenderness* Paradoxical bradycardia (vagal response caused by peritoneal blood)

Testing

* Type and screen* Rh- mother requires RhoGam if exposed to fetal blood* Transfusion if develops hemorrhagic shock* Pelvic ultrasound* If no intrauterine pregnancy (IUP) is seen in a pregnant patient, regardless of B-hCG level, the patient might have an ectopic pregnancy* B-hCG quantitative* If no IUP is seen and >1500, strongly suspect ectopic pregnancy* If no IUP is seen and <1500, ectopic pregnancy is still possibile

Treatment

* If patient has no IUP and hCG >1500, consult OBGYN* If patient has no IUP and hCG < 1500, disposition based on clinical appearance

Additional Reading

* Ectopic pregnancy overview (Medscape)