Case Scenario

It's 3 pm and you are finishing up your day in clinic.  A 25 year old female presents complaining of vaginal spotting for one day.  She has mid line abdominal pain which is similar to her menstrual cramps.  She performed a home pregnancy test and it was positive.  Her last menstrual period was 6 weeks ago.  You examine the patient and obtain the following information
 

  • PMHx- none
  • Gyn hx-  G0,   chalmydia once previously,  unmarried
  • Vital signs: 120/70  86  18  37
  • General physical: unremarkable
  • No fetal heart tones are present
  • Abdomen:  mild supra pubic tenderness
  • Pelvic: moderate blood in the vaginal vault, no tissue extruding from the os, which is closed.  The uterus is not palpably enlarged, no adnexal masses or tenderness are noted.  On Cervical motion the patient experiences discomfort on the right
  • B-HCG level 1200, Hct  37
You are of course concerned about the possibility of an ectopic pregnancy.  You've seen many similar patients, and it seems none have an ectopic pregnancy.  You consider discharging the patient, to have her follow-up with an ultrasound tomorrow.   You wonder if it is possible to more precisely estimate the risk of ectopic pregnancy in this patient.  Therefore, you turn to your computer to seek an answer.

After searching several databases of clinical guidelines you go to OVID's Medline database.