Key Points In hemodynamically stable patients, the history and physical are insufficiently accurate to either rule in or rule out ectopic pregnancy. The threshold should be very low to enter a patient with early pregnancy and symptoms or signs potentially referable to ectopic pregnancy into a rule out ectopic process. In contrast to what most of us were taught, the index beta HCG measurement does not discriminate among ectopic pregnancy, failed/failing intrauterine pregnancy, and early/healthy intrauterine pregnancy with sufficient accuracy to guide decision-making. Put more simply, the beta does not help you. If the ultrasound shows no IUP or ectopic, do not be reassured by a low beta and do not be alarmed by a high beta. The patient may have a healthy IUP, she may have a nonviable IUP that is miscarrying or will miscarry, or she may have an ectopic pregnancy; the beta doesn’t make any of these three diagnoses more or less likely enough to be a useful test to us, on the index visit. This is not controversial, the evidence is plentiful [1, 2, 3, 4, 5, 6, 7], and ACEP’s recent clinical policy states at a Level B recommendation, “Do not use the beta-hCG value to exclude the diagnosis of ectopic pregnancy in patients who have an indeterminate ultrasound.” If the beta is a million zillion, feel free to diagnose molar pregnancy. If IUP is confirmed by ultrasound, measurement of quantitative beta is unnecessary. If ultrasound shows no evidence of IUP or ectopic, a quantitative HCG level should be sent but the…
575. First trimester bleeding ddx / Management of threatened miscarriage / Options for management of inevitable miscarriage / Advice to patients with threatened or inevitable miscarriageNovember 3rd, 2008
by reuben in .vaginal bleeding, ectopic, pregnancy
Progestin-only regimen: medroxyprogesterone (Provera) 10 mg po qd x 10 days. Minimal DVT risk without estrogen.
by reuben in .vaginal bleeding, pregnancy
by reuben in .vaginal bleeding, ectopic