In this post, I link to and excerpt “Missed Ectopic Pregnancy” From EM Quick Hits 41 – IO Limitations, Missed Ectopic Pregnancy, Bronchiolitis O2 Monitoring, DRE in Cauda Equina Syndrome, Withdrawal of Life Sustaining Care.
All that follows is from the above resource.
Topics in this EM Quick Hits podcast
Anand Swaminathan on limitations and practical tips on intraosseus access (0:58)
Tahara Bhate QI corner on missed ectopic pregnancy (11:38)
Sarah Reid from EM Cases Summit on oxygen saturation monitoring in bronchiolitis and management of infant gastro-esophageal reflux (22:35)
Brit Long on the value of rectal exam in diagnosis of cauda equina syndrome (28:40)
Hans Rosenberg & Ariel Hendin on withdrawal of life-sustaining care in the ED (32:26)
Missed ectopic pregnancy
- Ectopic pregnancy presents with the classic triad of pain, amenorrhea, and vaginal bleeding only about 50% of the time
- There is no combination of history, physical and blood work that definitively rules out ectopic pregnancy (there are even case reports of undetectable serum BhCG with confirmed ruptured ectopic pregnancy!)
- Despite a meta-analysis of studies of ED point of care pelvic ultrasound (PoCUS) showing a sensitivity of 99.3% and a NPV of 99.6% for the diagnosis of ectopic pregnancy there remains inter-operator skill variability and cases are missed; consider a quality assurance program for PoCUS, as recommended by CAEP, such as an archive and review system that flags and addresses discrepancies for your ED
- Use of PoCUS for the diagnosis of ectopic pregnancy may result in shorter length of stay in the ED and faster time to definitive treatment for ruptured ectopic when compared to radiology-based ultrasound alone based on the literature