Obstetric Emergencies

Answer 1 Obtain a urine β-hCG measurement. When a woman of childbearing age presents to the ED with abdominal pain, vaginal bleeding, dizziness, or syncope, the diagnosis of ectopic pregnancy must be entertained. It is important to confirm the presence of absence of a pregnancy by ordering a β-hCG. A urine point-of-care pregnancy test is the quickest way to obtain β--hCG results. The patient’s abdomen is mildly tender, which could be a sign of blood irritating the peritoneal cavity. Therefore, it is also important to check the patient’s hemoglobin/hematocrit levels if a ruptured ectopic pregnancy is suspected, but this is not necessarily the initial step in this case. The patient’s treatment path depends on whether she is pregnant. Although not the first step, urinalysis is important to determine if there is another cause of lower abdominal pain (eg, urinary tract infection). RhoGam should be given to Rh-negative women with bleeding to prevent isoimmunization. However, it does not need to be given immediately upon confirmation of pregnancy. The dose of RhoGam differs depending on gestational age (< 12 wk, 50 μg; > 12 wk, 300 μg).1,2 REFERENCES 1. Brennan DF. Ectopic pregnancy-part I: clinical and laboratory diagnosis. Acad Emerg Med 1995;2:1081–9. 2. Murray H, Baakdah H, Bardell T, Tulandi T. Diagnosis and treatment of ectopic pregnancy. CMAJ 2005;173:905–12. Click here to return to the questions

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