J N Hendry1, Y Naidoo. 1. Department of Emergency Medicine, Waikato Hospital, Hamilton, New Zealand. jwhendry@telusplanet.net
Abstract
OBJECTIVES: To determine if patients with abdominal pain and vaginal bleeding during the first trimester of pregnancy who have a low clinical likelihood of ectopic pregnancy are put at risk of adverse events by delaying ultrasonography 12-18 h after emergency department presentation. METHODS: A retrospective chart review of all surgically proven ectopic pregnancies at our Institution over a 2-year period. RESULTS: One hundred and seventeen cases of ectopic pregnancy were reviewed. Thirty-seven cases met predetermined criteria of 'clinical stability' at first presentation. These patients waited a median 14 h for diagnostic ultrasound with 62% waiting more than 12 h. No adverse events occurred while waiting for this diagnostic study. CONCLUSIONS: Preliminary results suggest that pregnant patients with abdominal pain and vaginal bleeding in the first trimester who meet specific low-risk clinical criteria could potentially have ultrasound delayed 12-18 h without risk of adverse event. Further prospective studies are warranted to confirm the safety of this strategy.
OBJECTIVES: To determine if patients with abdominal pain and vaginal bleeding during the first trimester of pregnancy who have a low clinical likelihood of ectopic pregnancy are put at risk of adverse events by delaying ultrasonography 12-18 h after emergency department presentation. METHODS: A retrospective chart review of all surgically proven ectopic pregnancies at our Institution over a 2-year period. RESULTS: One hundred and seventeen cases of ectopic pregnancy were reviewed. Thirty-seven cases met predetermined criteria of 'clinical stability' at first presentation. These patients waited a median 14 h for diagnostic ultrasound with 62% waiting more than 12 h. No adverse events occurred while waiting for this diagnostic study. CONCLUSIONS: Preliminary results suggest that pregnant patients with abdominal pain and vaginal bleeding in the first trimester who meet specific low-risk clinical criteria could potentially have ultrasound delayed 12-18 h without risk of adverse event. Further prospective studies are warranted to confirm the safety of this strategy.