Ectopic Pregnancy / Threatened Abortion

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