Ectopic Pregnancy

1. Description of the problem

What every clinician needs to know

Ectopic pregnancy needs to be considered in adolescent women with severe abdominal pain. Symptoms often appear 6-8 weeks after the last menstrual period and include abdominal pain and occasionally vaginal bleeding. The most significant risk is a ruptured ectopic pregnancy.

Clinical features

Abdominal pain in a female of reproductive age

Amenorrhea

Vaginal bleeding

Key management points

1. Stabilization of hemodynamics

2. Surgical management unless non-emergent, in which case methotrexate as medical management can be considered.

3. Diagnosis

Transvaginal ultrasound – can be used to detect an ectopic or intrauterine pregnancy.

Human chorionic gonadotropin (hCG) – may be helpful, although interpretation can be difficult and requires serial hCG levels in the absence of a transvaginal ultrasound.

A gestational sac should be detected by transvaginal ultrasound if the hCG is greater than 800-1000 IU/L, and thus the abscence of a sac with higher hCG is concerning for an ectopic pregnancy.

4. Specific Treatment

Medical therapy – methotrexate may be used for ectopic pregnancies and has been shown to be as effective as surgical treatment; however, most emergency situations require a surgical approach.

Surgical therapy – many ectopic pregnancies require a surgical approach to prevent rupture, especially when presentation is late.

Prognosis

The prognosis for an ectopic pregnancy is excellent if treated before rupture. Long-term prognosis depends most on any associated complications.