Critical Care Medicine
Gastrointestinal Emergencies: 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.
Abdominal pain in a female of reproductive age
Key management points
1. Stabilization of hemodynamics
2. Surgical management unless non-emergent, in which case methotrexate as medical management can be considered.
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.
The prognosis for an ectopic pregnancy is excellent if treated before rupture. Long-term prognosis depends most on any associated complications.
Copyright © 2017, 2013 Decision Support in Medicine, LLC. All rights reserved.
No sponsor or advertiser has participated in, approved or paid for the content provided by Decision Support in Medicine LLC. The Licensed Content is the property of and copyrighted by DSM.
Renal and Urology News Articles
- For Treating Uremic Pruritus, Evidence is Strongest for Gabapentin
- IgG-Degrading Enzyme Desensitizes, Permits HLA-Incompatible Transplant
- Evaluating Practice Options in the Shifting Health Care Landscape
- Melanoma Risk Higher in Kidney Transplant Recipients
- Not All High-Risk Prostate Cancers Are the Same
Sign Up for Free e-newsletters
NEPHROLOGY & UROLOGY NEWS
- Acute Kidney Injury (AKI)
- Chronic Kidney Disease (CKD)
- Contrast Nephropathy
- Cardiovascular Disease (CVD)
- Diabetic Nephropathy
- End-stage Renal Disease (ESRD)
- Lupus Nephritis
- Peritoneal Dialysis
- Secondary Hyperparathyroidism (SHPT)