1. Easily Missed
Ectopic Pregnancy

2. How common is it?
Estimated at 11.1 cases per 1,000 reported pregnancies
12% of ectopic pregnancies were missed at initial presentation
In A&E, 45% were discharged with the wrong diagnosis

3. What are the known risk factors?
History of ectopic pregnancy
Pelvic inflammatory disease
Previous tubal surgery
Fertility treatment
Smoking
Multiple sexual partners

4. When should it be suspected?
Unilateral lower abdominal pain
Amenorrhea
Positive pregnancy test
Known risk factors

5. How is it definitively diagnosed?
Transvaginal ultrasound
Measurement of human chorionic gonadotrophin

6. Why is it missed? Failure to consider a possible pregnancy
Failure to place importance on known risk factors
Failure to consider an ectopic pregnancy in the differential diagnosis
Failure to arrange suitable follow-up

7. Why does this matter? In most cases, surgery is no longer needed
Can be treated safely and effectively with Methotrexate
Late diagnosis could lead to tubal rupture requiring emergency surgery

8. What to do in Custody Take a history and examine the patient
If they have Unilateral low pain; Amenorrhea; +ive pregnancy test
If there is a history of: Ectopic pregnancy, Pelvic inflammatory disease, Previous tubal surgery, Fertility treatment, Smoking, Multiple sexual partners (one, many or all of these factors)
Refer to A&E with a note of your differential diagnosis

9. Summary Ectopic pregnancy is easily missed
Consider ectopic pregnancy in patients with: Unilateral low abdominal pain – Amenorrhea – Known risk factors – positive pregnancy test
Definitive diagnosis can only be made in hospital
Refer to A&E