TUESDAY April 23, 2013 — Ectopic pregnancy, in which the fertilized egg grows in the fallopian tubes or other spots outside the uterus, typically leads to miscarriage and can even prove fatal.
Now, a review of the data finds that taking a patient’s history along with a clinical exam is not enough to diagnose the condition in women with abdominal pain or vaginal bleeding during early pregnancy.
Instead, the researchers concluded that transvaginal ultrasound is the single best way to evaluate suspected ectopic pregnancy. These scans examine a woman’s reproductive organs, including the uterus, ovaries, cervix and vagina.
One expert not connected to the study said detecting ectopic pregnancy early on is crucial.
“Risks from this complication include hemorrhage from rupture, death, and loss of the [fallopian] tube, either from rupture or surgical removal,” said Dr. Kecia Gaither, vice chair of obstetrics & gynecology and director of maternal-fetal medicine at Brookdale University Hospital and Medical Center, in New York City. “Patients typically present with abdominal pain, spotting and a positive pregnancy test.”
Nevertheless, “fewer than half of the women with an ectopic pregnancy have the classically described symptoms of abdominal pain and vaginal bleeding. In fact, these symptoms are more likely to indicate miscarriage,” wrote the team of researchers led by Dr. John Crochet of the Center of Reproductive Medicine in Webster, Texas. That means that confirming a diagnosis of ectopic pregnancy is especially important.
For this review, published in the April 24 issue of the Journal of the American Medical Association, the researchers analyzed 14 studies that included a total of more than 12,000 patients.
The study confirms that “the gold standard for diagnosis is an ultrasound,” Gaither said. “Depending on the clinical stability of the patient, a laparoscopic surgical procedure or a laparotomy may [also] be required,” she added.
“For any patient who is pregnant in the first trimester — and has not had a sonogram — who experiences sudden onset of abdominal pain and spotting, it is important to go to the nearest hospital to be evaluated for an ectopic pregnancy,” Gaither said. “The trip may be lifesaving.”
One other expert agreed.
“Ectopic pregnancy poses such a risk to patients of childbearing age that it should always be considered when a patient is pregnant and has abdominal pain,” said Dr. Jennifer Wu, an obstetrician/gynecologist at Lenox Hill Hospital, in New York City. “Good surveillance with early ultrasound and close follow-up … can significantly lessen risks, which include emergency surgery and transfusion.”
According to background information in the review, ectopic pregnancy is the leading cause of pregnancy-related death in the first trimester and causes up to 6 percent of pregnant women’s deaths in the early stages of pregnancy.
The American Academy of Family Physicians has more about ectopic pregnancy.