Main Error — Failure to THINK ECTOPIC for woman age 9-59 with new low abdominal pain
Onset of abdominal pain >6 wks post-LMP (usually 6-8 wks, can occur later)
- Requires careful inquiry re timing, flow & duration of last several menses
- BEWARE: vaginal bleed from ruptured ectopic confused with menses
- BEWARE: implantation spotting (5-6 wks post LMP) confused with menses
- Menstrual Hx NOT USEFUL for woman with irregular cycles
- Threatened Abortion presents very similarly, but can occur at any time in pregnancy
May have other pregnancy-associated Sx
- Breast Tenderness
- Nausea
- Urinary Frequency
Physical Exam not reliable to either Dx or R/O ectopic
OBTAIN Urine Pregnancy Test (UCG) on all sexually-active women with low abd pain
- Regardless of prior Tubal Ligation
- Obtain on patients who deny recent sex but whose overall history suggests they may not be forthcoming
NEGATIVE UCG rules out ectopic
POSITIVE UCG requires trans-vaginal ultrasound in ER, plus serial serum HCG’s
- Normal intrauterine pregnancy PLUS normal doubling times of HCG rules out ectopic, suggesting Threatened Abortion
- Recent IVF attempt is tricky: possible twin ectopic
DiagnosisDude 