Emergency Medicine Myths: Ectopic Pregnancy Evaluation, Risk Factors, and Presentation

Jennifer J. Robertson, Brit Long, Alex Koyfman

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background: Ectopic pregnancy (EP) is an important cause of morbidity and mortality in females of reproductive age. Proper diagnosis and treatment are critical, as complications such as rupture, hemorrhagic shock, and even death can occur. Objective: EP is a condition emergency physicians are trained to detect, yet there are multiple myths concerning its evaluation and diagnosis. This article reviews several of these myths in order to improve emergency department (ED) evaluation and diagnosis. Discussion: EP is a difficult diagnosis and may be missed on initial ED visit. While the diagnosis is often delayed simply due to very early presentations, it can also be missed because of the following factors: patients may not have all the same risk factors or demonstrate the same symptoms. They may also not demonstrate the same serum B-human chorionic gonadotropin levels and trends or have the same ultrasound findings at equivalent gestational ages. Some patients with early EP may have positive ultrasound findings with serum β-hCG levels under a defined discriminatory zone (DZ). On the other hand, some patients with an early viable intrauterine pregnancy may have no visible findings on initial ultrasound, but have serum β-hCG (quantitative) levels well above the DZ. Although rare, EP has even been demonstrated in women with negative urine β-hCG tests or low serum β-hCG levels. Conclusions: While EP may be a challenging diagnosis, understanding the myths surrounding EP may help emergency physicians consider it, even when patient risk factors, symptoms, or ED laboratory or imaging studies do not initially or easily define the diagnosis.

Original languageEnglish (US)
JournalJournal of Emergency Medicine
DOIs
StateAccepted/In press - 2017

Fingerprint

Emergency Medicine
Ectopic Pregnancy
Hospital Emergency Service
Serum
Emergencies
Physicians
Hemorrhagic Shock
Chorionic Gonadotropin
Gestational Age
Rupture
Urine
Morbidity
Pregnancy
Mortality

Keywords

  • Discriminatory zone
  • Ectopic
  • Pregnancy
  • Serum β-hCG
  • Ultrasound

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Emergency Medicine Myths : Ectopic Pregnancy Evaluation, Risk Factors, and Presentation. / Robertson, Jennifer J.; Long, Brit; Koyfman, Alex.

In: Journal of Emergency Medicine, 2017.

Research output: Contribution to journalArticle

@article{f98174fb5caf46a0aec3426013d60de1,
title = "Emergency Medicine Myths: Ectopic Pregnancy Evaluation, Risk Factors, and Presentation",
abstract = "Background: Ectopic pregnancy (EP) is an important cause of morbidity and mortality in females of reproductive age. Proper diagnosis and treatment are critical, as complications such as rupture, hemorrhagic shock, and even death can occur. Objective: EP is a condition emergency physicians are trained to detect, yet there are multiple myths concerning its evaluation and diagnosis. This article reviews several of these myths in order to improve emergency department (ED) evaluation and diagnosis. Discussion: EP is a difficult diagnosis and may be missed on initial ED visit. While the diagnosis is often delayed simply due to very early presentations, it can also be missed because of the following factors: patients may not have all the same risk factors or demonstrate the same symptoms. They may also not demonstrate the same serum B-human chorionic gonadotropin levels and trends or have the same ultrasound findings at equivalent gestational ages. Some patients with early EP may have positive ultrasound findings with serum β-hCG levels under a defined discriminatory zone (DZ). On the other hand, some patients with an early viable intrauterine pregnancy may have no visible findings on initial ultrasound, but have serum β-hCG (quantitative) levels well above the DZ. Although rare, EP has even been demonstrated in women with negative urine β-hCG tests or low serum β-hCG levels. Conclusions: While EP may be a challenging diagnosis, understanding the myths surrounding EP may help emergency physicians consider it, even when patient risk factors, symptoms, or ED laboratory or imaging studies do not initially or easily define the diagnosis.",
keywords = "Discriminatory zone, Ectopic, Pregnancy, Serum β-hCG, Ultrasound",
author = "Robertson, {Jennifer J.} and Brit Long and Alex Koyfman",
year = "2017",
doi = "10.1016/j.jemermed.2017.08.074",
language = "English (US)",
journal = "Journal of Emergency Medicine",
issn = "0736-4679",
publisher = "Elsevier USA",

}

TY - JOUR

T1 - Emergency Medicine Myths

T2 - Ectopic Pregnancy Evaluation, Risk Factors, and Presentation

AU - Robertson, Jennifer J.

AU - Long, Brit

AU - Koyfman, Alex

PY - 2017

Y1 - 2017

N2 - Background: Ectopic pregnancy (EP) is an important cause of morbidity and mortality in females of reproductive age. Proper diagnosis and treatment are critical, as complications such as rupture, hemorrhagic shock, and even death can occur. Objective: EP is a condition emergency physicians are trained to detect, yet there are multiple myths concerning its evaluation and diagnosis. This article reviews several of these myths in order to improve emergency department (ED) evaluation and diagnosis. Discussion: EP is a difficult diagnosis and may be missed on initial ED visit. While the diagnosis is often delayed simply due to very early presentations, it can also be missed because of the following factors: patients may not have all the same risk factors or demonstrate the same symptoms. They may also not demonstrate the same serum B-human chorionic gonadotropin levels and trends or have the same ultrasound findings at equivalent gestational ages. Some patients with early EP may have positive ultrasound findings with serum β-hCG levels under a defined discriminatory zone (DZ). On the other hand, some patients with an early viable intrauterine pregnancy may have no visible findings on initial ultrasound, but have serum β-hCG (quantitative) levels well above the DZ. Although rare, EP has even been demonstrated in women with negative urine β-hCG tests or low serum β-hCG levels. Conclusions: While EP may be a challenging diagnosis, understanding the myths surrounding EP may help emergency physicians consider it, even when patient risk factors, symptoms, or ED laboratory or imaging studies do not initially or easily define the diagnosis.

AB - Background: Ectopic pregnancy (EP) is an important cause of morbidity and mortality in females of reproductive age. Proper diagnosis and treatment are critical, as complications such as rupture, hemorrhagic shock, and even death can occur. Objective: EP is a condition emergency physicians are trained to detect, yet there are multiple myths concerning its evaluation and diagnosis. This article reviews several of these myths in order to improve emergency department (ED) evaluation and diagnosis. Discussion: EP is a difficult diagnosis and may be missed on initial ED visit. While the diagnosis is often delayed simply due to very early presentations, it can also be missed because of the following factors: patients may not have all the same risk factors or demonstrate the same symptoms. They may also not demonstrate the same serum B-human chorionic gonadotropin levels and trends or have the same ultrasound findings at equivalent gestational ages. Some patients with early EP may have positive ultrasound findings with serum β-hCG levels under a defined discriminatory zone (DZ). On the other hand, some patients with an early viable intrauterine pregnancy may have no visible findings on initial ultrasound, but have serum β-hCG (quantitative) levels well above the DZ. Although rare, EP has even been demonstrated in women with negative urine β-hCG tests or low serum β-hCG levels. Conclusions: While EP may be a challenging diagnosis, understanding the myths surrounding EP may help emergency physicians consider it, even when patient risk factors, symptoms, or ED laboratory or imaging studies do not initially or easily define the diagnosis.

KW - Discriminatory zone

KW - Ectopic

KW - Pregnancy

KW - Serum β-hCG

KW - Ultrasound

UR - http://www.scopus.com/inward/record.url?scp=85032381785&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85032381785&partnerID=8YFLogxK

U2 - 10.1016/j.jemermed.2017.08.074

DO - 10.1016/j.jemermed.2017.08.074

M3 - Article

C2 - 29110976

AN - SCOPUS:85032381785

JO - Journal of Emergency Medicine

JF - Journal of Emergency Medicine

SN - 0736-4679

ER -