Critical Care Medicine

Gastrointestinal Emergencies: Ectopic Pregnancy

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.

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