Author: Mark Winstanley / Editor: Andrew Tabner / Reviewer: Andrew Tabner, Philip Delbridge / Codes: ObC4, ObP3, SLO1, SLO2 / Published: 18/02/2020 / Reviewed: 07/11/2024
A 27-year-old lady presents to the Emergency Department (ED) with a 4 hour history of lower abdominal pain.
She describes the pain as constant and rates the severity at 4-5 out of 10. She has no bowel or bladder problems and no nausea or vomiting. There is no vaginal bleeding and she has never been pregnant. Her last menstrual period was 6 weeks ago. She is usually fit and well. She is taking the progesterone-only contraceptive pill but otherwise no medications and she has no known allergies. She took a pregnancy test at home this morning which was negative.
Examination reveals a tender lower abdomen without guarding. There is no renal angle tenderness and no palpable mass is present. Bowel sounds are present. Observations are recorded as HR 95 bpm regular, BP 135/89, Temp 36.8
Module Content
Bleeding in Pregnancy
This session covers the emergency management of both bleeding in early pregnancy and antepartum haemorrhage (APH) Appropriate investigation and initial emergency interventions are considered including rhesus status and the administration of anti-D immunoglobulin.
Medical Assessment of the Pregnant Patient in the Emergency Department
This blog isn’t an all-encompassing guide, but suggestions of some of the more common considerations about managing pregnant patients in the ED.
Abdominal Pain without Shock
This article covers the generic assessment and management of the pain with abdominal pain without shock.
32 Comments
concise and clear
concise and very clear
On point with approach and management pathway
quick AND CLEAR
Great to learn about the place of conservative management in stable patients with ectopic gestation.
Simple case- interesting that not all ectopics necessarily need urgent surgery. considerations of pain and PV bleeding.
very clear and concise case study.
Good – good reminder for trainees that ectopic pregnancy cannot be excluded with negative urine hcg.
Good explanation on surgical management when is it required
good reminder.
Good revision
ectopic pregnancy a common presentation – good recall
Great, short and to the point. relevant clinical scenario.
Concise and informative
Good revision
Very interesting, in particular the last question regarding surgery. Thanks.
Frequently seen presentation, good refresher
Great case
useful
Hot Topic for exam, Good revision
good history and tests specific
Consider Pregnancy test in any case of CBP even if she is on OCP
Concise case study.
good
Good refresh case
a very nice case. hemodynamic stability, degree of PVB and perotinitic in the abdomen are key factors in the management of Ectopic pregnancy.
good case
I had not considered discharge from the ED before. Interesting, thank you.
Short and sweet!
Thank you for highlighting the distress these women often go through.
All females in the childbearing age (as young as 12 or if they have got a period ) should get a pregnancy test, especially if they have come in with abdominal pain.
Good knowledge refreshment
Lovely! Excellent read. A better explanation of when to go for methotrexate vs surgical treatment would have been great! 👍🏼
Good recall of relevant information