Basildon EM Handbook 2018

Ectopic pregnancy

March 2018 | by EMauthor

This is the most serious gynaecological emergency as it can either present with hypovolaemic shock or else the shock can develop very rapidly.  Consider this diagnosis in all women of childbearing age who presents with the any or combination of the following

•Abdominal pain

•Vaginal bleeding

•Collapse or syncope

•Amenorrhoea can be present but might be absent or patient might have had irregular period

•Patient may present with signs of hypovolaemic shock and any of the above

Predisposing factors include PID, Tubal surgery, previous ectopic pregnancy, IUD use, and Post sterilization.  Vaginal examination may reveal unilateral adnexial tenderness or cervical excitation and the uterus can be either normal or slightly enlarged.  

•Urine BhCG should be done in all of the above cases, a positive test will strengthen the suspicion and a negative one has a good NPV

Management

•IV access with two large bore cannulas

•IV fluids stat

•Blood for FBC, U&Es, Clotting and group and screen

•Refer all cases of suspected ectopic pregnancy to the Gynaecology SHO  

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