It is 2 am and the radiology suite is closed. A 25-year-old F comes in with pregnant abdominal pain and vaginal bleeding. She is approximately 8-weeks by dates. She is in pain. On exam, she has severe lower abdominal tenderness and diffuse pain on the gyn exam. On bedside sono, there is no IUP. There is a small amount of free fluid, fluid around the right ovary, and both ovaries appear normal. Gyn is consulted. The hcg is 1100. After seeing the patient and repeating the sono, the gyn resident recommends discharging the patient and having her return for a repeat beta in 48 hours. What do you do?
this is either a passed miscarriage or pregnancy of unknown location; i.e. ectopic until proven otherwise. did this pt ever have an IUP confirmed in her pregnancy?
-if had confirmed IUP before would pain control, reassess vitals in ED, if stable dc w/ the repeat beta in 48 hrs
-if no confirmed IUP need to keep for formal sono for possible ectopic
Don’t discharge with severe tenderness and concern for ectopic. Call the Gyn attending and ask for them to examine the patient.