Indicators of potential for rupture for ectopics seen in the emergency department

BACKGROUND: Emergency departments (ED) frequently evaluate patients with probable ectopic pregnancies who go home and may rupture. It would be beneficial to know which patient factors are associated with rupture and which are not. OBJECTIVES: The purpose of this study was to determine which ED patients with ectopic pregnancies are at risk for rupture. MATERIALS AND METHODS: This study was a retrospective chart review of all women aged ≥18 years during a 5-year period who were diagnosed with ectopic pregnancy to a level I ED. Data collected included basic demographic information, medical, surgical, obstetric and gynecologic history, social and sexual history, findings on physical examination, and laboratory values such as urine pregnancy test, β-hCG, and complete blood count. RESULTS: There was a significant difference using a multivariate regression analysis with 95% CI in history findings of abdominal pain, nausea, vomiting, and urinary tract symptoms. There was a significant difference in physical examination of pulse, diastolic pressure, abdominal tenderness, peritoneal signs, cervical motion tenderness, and adnexal tenderness. There was also a significant difference in β-hCG, hemoglobin and hematocrit results and ultrasound findings of free peritoneal fluid, intrauterine pregnancy and cardiac findings between those who ruptured and those who did not. None of these tests was able to differentiate those that would go on to rupture. CONCLUSION: The result of the study did not find any single sign, symptom, or test that could reliably differentiate patients who have a ruptured ectopic from those who do not. However, β-hCG over 1500 mIU was the best variable in explaining the variation between those who would or would not go on to rupture after their ED visit.