Ectopic Pregnancy: Is It Really an Enormous Phobia for Emergency Physicians?

Abstract

Objectives: Any pregnancy in which the implantation occurs outside the uterine cavity is defined as ectopic pregnancy (EP). Approximately 2% of all pregnancies are diagnosed as ectopic pregnancy. Ruptured EP is the most life-threatening emergency in the first trimester of pregnancy. The objective of this study is to determine the incidence of unstable ectopic pregnancy with abnormal vital signs and to find out the risk factors.
Materials and Methods: This retrospective study was conducted in a university emergency department with 50.000 annual visits per year. Patients diagnosed as ectopic pregnancy between 2002 and 2007 were determined from the computerized database (Mediacil® software) of the hospital and enrolled to the study. The age of the patient, symptoms and vital signs at the presentation, ectopic pregnancy risk factors, the human chorionic gonodatrophin (hCG) levels and the treatment choice were recorded.
Results: Sixty-three patients diagnosed as ectopic pregnancy during the study period. The mean age of patients was 29.9±5.3 (min 21- max 44). The prevalence of ectopic pregnancy in our patient population was 3.4%. Six (9.5%) of all the ectopic pregnancy patients, evaluated in the emergency department had unstable vital signs and 4 patients (6.3%) presented with syncope. 20.6% of all the patients in the study had high risk, 27% of them had moderate risk and 52.4% had low risk. History of previous ectopic pregnancy were the most seen risk factor among the high risk factors (n=12, 19%).
Conclusion: The most common emergency department symptoms of ectopic pregnancy are abdominal pain and vaginal bleeding. Especially the patients with previous ectopic pregnancy are risky for a recurrent ectopic pregnancy. All female patients in childbearing age disregarding the vital signs should be evaluated for an ectopic pregnancy.