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Ectopic Pregnancy, Emergency Medicine

Reviewed 06/2017
 


Basics

Description

  • Implantation of fertilized ovum outside of uterus:

    • Most commonly fallopian tube (93–97%)

  • Abdominal and peritoneal implantations:

    • Associated with higher morbidity

    • Difficulty in diagnosis

    • T...

Diagnosis

Signs and Symptoms

Classic triad of amenorrhea, vaginal bleeding, and abdominal pain are present in only 15% of women with ectopic pregnancies: 
  • Amenorrhea (75–95%)

  • Abdominal pain (80–100%):

    • Fre...

Treatment

Pre-Hospital

Cautions: Female patients of childbearing age presenting in shock may have unrecognized ruptured ectopic pregnancy 

Initial Stabilization/Therapy

  • Vital signs unstable:

    • Airway manage...

Follow-Up

Disposition

Admission Criteria

  • Any patient with confirmed ectopic pregnancy who is hemodynamically unstable

  • Unreliable patients with increased risk factors, no available US, β-hCG >6,500 wit...

Pearls and Pitfalls

  • Always obtain a pregnancy test on women of childbearing age

  • Obtain serum hCG and transvaginal ultrasonography in all women with positive pregnancy test presenting with abdominal pai...

Additional Reading

  • Barnhart  KT. Clinical practice. Ectopic pregnancy. N Engl J Med.  2009;361:379–387.

  • Crochet  JR, Bastian  LA, Chireau  MV. Does this woman have an ectopic pregnancy?: The ratio...

Codes

ICD9

  • 633.00 Abdominal pregnancy without intrauterine pregnancy

  • 633.10 Tubal pregnancy without intrauterine pregnancy

  • 633.90 Unspecified ectopic pregnancy without intrauterine pregnancy

  • 633.80 Other ...

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