Summary of Key Points

1. You should consider ectopic pregnancy in every patient who is capable of bearing children

2. If a patient of child bearing age presents with severe abdominal pain or vaginal bleeding and is either hemodynamically unstable or very ill appearing, this is a ruptured  ectopic pregnancy until proven otherwise and I would recommend performing a bedside FAST exam immediately.

3. Remember that the discriminatory zone for TVUS is approximately 1500.  

4. Don’t forget your three ACEP clinical policies on this topic: just to remind you, 

4a.  It is a level B ACEP clinical policy to obtain a TVUS in every stable pregnant patient presenting with abdominal pain or vaginal bleeding, regardless of serum b-HCG level

4b.  There is also a level B ACEP clinical policy stating that in patients with an indeterminate TVUS, you cannot use serum bHCG value to rule out ectopic pregnancy.

4c. It is a level C ACEP clinical policy to obtain specialty consultation or arrange close outpatient followup in all patients with an indeterminate TVUS result.

5. Although this isn’t an ACEP recommendation, ACOG recommends rhogam for all Rh negative women diagnosed with an ectopic pregnancy

6. Don’t forget to consider heterotopic pregnancy, especially if IVF was used to help conceive. 

Further Reading:

ACEP Clinical Policy – Early Pregnancy