Ectopic Pregnancy
EM Clerkship
Zack Olson, MD ; Mike Estephan, MD ; Maddie Watts, MD
4.9 • 818 Ratings
🗓️ 14 July 2019
⏱️ 16 minutes
🧾️ Download transcript
Summary
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)
Transcript
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| 0:00.0 | Hello, med students. |
| 0:02.0 | My name is Zach Olson, and thank you for downloading this week's episode of the EM Clerkship |
| 0:08.0 | podcast. |
| 0:10.0 | All right. |
| 0:11.0 | So we have covered the quadrant-based diagnoses, appendicitis, diverticulitis, biliary, |
| 0:17.1 | and pancreatitis. |
| 0:18.4 | We've covered our bowelis, bowel obstruction, bottle o'schemia, |
| 0:22.0 | bowel perforations, and bowel twisting, volvillus, volvili. This week is a big, big transition |
| 0:29.6 | on your differential because we are moving beyond GI causes of abdominal pain to another |
| 0:36.1 | big category, GU, genitoneary causes of abdominal pain to another big category, |
| 0:41.5 | GU, genitoneurinary causes of abdominal pain. |
| 0:44.4 | Still, critical diagnoses can't miss. |
| 0:48.5 | All is on your CDM fourth year recommended curriculum, so let's go. |
| 0:50.2 | Hello, Dr. Olson. |
| 0:56.7 | I have a 35-year-old female with no surgical history and no significant past medical history who presents with abdominal pain. She describes it as a continuous, suddenly worsening, lower |
| 1:03.6 | abdominal pain, and it's been worsening for about three days. She has had some vaginal |
| 1:07.8 | spotting. She denies fever, vomiting, vaginal discharge, stool changes, urinary symptoms, or any other symptoms at this time. |
| 1:15.0 | She is a febrile. |
| 1:16.3 | She doesn't have any tachycardia. |
| 1:18.3 | Vital signs are within normal limits. |
| 1:19.9 | On exam, she has moderate tenderness of the right lower quadrant with some voluntary guarding, but no involuntary guarding, no rebound. |
| 1:28.5 | I think it might be an ovarian cystic, actually, but we obviously have to rule out appendicitis, |
... |
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