I'm afraid that I'd reckon that a woman with early pregnancy presenting to
an ED with abdominal pain needs an ultrasound (and if she's having
infertility treatment I might still worry even if I saw an intrauterine
pregnancy). I accept that things are moving pretty slowly at present, but at
6- 7 weeks there's a fair chance that an intrauterine pregnancy would be
visible even with transabdominal ultrasound and a low level of expertise
(with referral for negative or equivocal results). This is another reason
why it is pretty difficult to defend running an ED without a scanner these
days. Ultrasound is cheap and safe. Why not do it? Having said that, that's
my view on what ought to be done/ policy. In practice it is entirely
possible that I'd look at the patient and think that all things considered a
scan wasn't needed.
> I think we can assume that hcg was positive as the original
> post said 6-7 weeks pregnant (in a fairly "confident" sort of
> way!). And as far as I'm aware a negative hcg does rule out
> ectopic, or at least rules out an ectopic that's going to
> cause any problems.
I thought it was the other way round: negative HCG rules out healthy
pregnancy, but ruptured ectopics can be found with low levels of HCG.
> Urine or blood BhCG result? Although that wouldn't rule out
> ectopic, it
> would provide evidence that there is / isn't a pregnancy.
As above, if you have a patient who has had a positive pregnancy test (or
who you otherwise think is pregnant), but a negative HCG, that points
towards ruptured ectopic.
Matt Dunn
Warwick.
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