OBSTETRICS AND GYNECOLOGYA 33-year-old female presents to the ED with left lower-quadrant pain. Her
LMP was 2 months ago. Vital signs are BP 90/60, HR 130, RR 18. Urine
pregnancy test is positive. An ultrasound is done (see Figure 12.1). What is
the next appropriate step?
Emergent consultation of OB/GYN for surgical treatment of ectopic pregnancy.ECTOPIC PREGNANCYEctopic pregnancy occurs when the conceptus is implanted outside of the
uterine cavity.
■ 95% are in the fallopian tube; other sites include ovary, abdominal cavity,
and cervix.
■ Ectopic pregnancy is common, occurring in 1–2% of all pregnancies.
■ Heterotopic pregnancy (simultaneous IUP and ectopic pregnancy) occurs
in only 1 in 4000 pregnancies but may occur in up to 3% of patients tak-
ingfertility treatment.
■ Risk factors include pelvic inflammatory disease (PID), tubal ligation, pre-
vious pelvic surgery, current use of an IUD, history of previous ectopic,
elective abortion, and fertility treatments.
FIGURE 12.1. Ultrasound of positive FAST with free fluid.
(Reproduced, with permission, from Plantz SH, Collman D, Gossman WG, et al. Emergency
Medicine Written Board Review,6th ed. New York: McGraw-Hill, 2006:439.)