Obstetric Emergencies

Answer 2 Order a formal pelvic ultrasound.To prevent a delayed diagnosis of ectopic pregnancy, pregnant women with abdominal pain or vaginal bleeding require evaluation by transvaginal ultrasonography. If a bedside endovaginal ultrasound is performed in the ED and is indeterminate (as in the case), demonstrating no definitive intrauterine pregnancy and the presence of free fluid in the pelvis, then a formal ultrasound is warranted. If an ectopic pregnancy is found on formal ultrasound, an obstetric/gynecologic consultation is required to evaluate for a ruptured ectopic pregnancy. Ectopic pregnancies can be treated surgically or medically with methotrexate, depending on the size of the ectopic pregnancy. Dilation and curettage may be considered if the patient is though to be aborting and continues to bleed, although the ultrasound does not demonstrate products of conception (Figure). If the patient is Rh-negative, RhoGam should be administered. The dose administered could be the microdose given based on the date of the woman’s last menstrual period/gestational age of fetus.2-4 REFERENCES 2. Murray H, Baakdah H, Bardell T, Tulandi T. Diagnosis and treatment of ectopic pregnancy. CMAJ 2005;173:905–12. 3. Mateer JR, Valley VT, Aiman EJ, et al. Outcome analysis of a protocol including bedside endovaginal sonography in patients at risk for ectopic pregnancy. Ann Emerg Med 1996;27:283–9. 4. Kaplan BC, Dart RG, Moskos M, et al. Ectopic pregnancy: prospective study with improved diagnostic accuracy. Ann Emerg Med 1996;28:10–7. Click here to return to the questions

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