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All women of childbearing age who present with abdominal pain need a pregnancy test

a 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