Ectopic Pregnancy Myths Addressed

December 22, 2017

Spoon Feed
Several myths surround the diagnosis of ectopic pregnancy (EP).  This review debunks them.

Why does this matter?
Harm can be done if we treat based on myth and not fact, especially with a high stakes diagnosis like EP.  This quick article unpacks the facts.

The diagnosis meant to humble us
Ultra-quick summary:

• A beta-HCG above the discriminatory zone (DZ) and no visible intrauterine pregnancy (IUP) does not automatically mean EP, though you need to strongly consider it.
• A beta-HCG below the DZ does not mean you definitely can’t see anything on US. In fact, up to half of ruptured EP have beta-HCG below the DZ.
• Don’t rely on beta-HCG trends to rule in or out EP.  Levels of beta-HCG generally won’t rise normally in EP, but don’t count on it.
• Patients with EP may not always present with pain and adnexal tenderness. They may have only bleeding, syncope, or other atypical presentation.
• Patients with ruptured EP may have a negative urine pregnancy or low serum beta-HCG.
• The overall effect of OCPs and IUDs is a reduction in EP, not an increase. However, when the contraception fails, the risk of an EP increases.
• Most patients with EP have no predisposing risk factors.

Source
Emergency Medicine Myths: Ectopic Pregnancy Evaluation, Risk Factors, and Presentation.  J Emerg Med. 2017 Oct 27. pii: S0736-4679(17)30783-7. doi: 10.1016/j.jemermed.2017.08.074. [Epub ahead of print]

Peer reviewed by Thomas Davis, MD.