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Article Tags:
Vaginal bleeding
Pelvic pain
Period pain a month after sex
My period's not normal
Abnormal menstruation
What is an ectopic pregnancy?
Do I have an ectopic?
Am I pregnant?
Girlfriend might be pregnant?
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Sometimes not knowing you're pregnant is dangerous, period.

October 20, 2016

Matthew Vasey MD


Department of Emergency Medicine, Tampa General Hospital | Teamhealth, an affiliate of University of South Florida

Disclosure: Opinions reflect neither employer nor affiliated institutions, soley those of the author.



Whether ascribed to Henri Bergson or Robertson Davies, if we believe "the eyes see only what the mind is prepared to comprehend" then some information to stretch intellectual boundaries may be warranted. One could assume young females promptly familiarize themselves with the natural physiology of the menstrual cycle and possibility of pregnancy. To recap, this yields a nearly monthly hormone regulated process characterized by repeated production of reproductive egg "ovulation" from an ovary, followed by a vaginal bleeding "period" or "menstruation" unless during the brief window "fertilization" from a male partners sperm received during sex results in a pregnancy "zygote" settling within the uterus where a baby develops over nine months. The purpose of this article to inform readers the fertilized egg does not always settle in the appropriate location in the uterus.

When the fertilized egg settles in the anatomic tunnel "fallopian tube" between the ovary and uterus and grows, a woman has the most common location of ectopic pregnancy. Ectopic pregnancy is the leading cause of death for pregnant women in the first trimester. (2) The dangerous part about this is many women experience the often vague signs of ectopic at a time when they don't know they are even pregnant. A women can have an ectopic even without any risk factors. (1) I wish I could say there was a straight forward, if you experience x + y you have z but that is not the case with ectopic. The only way to identify an ectopic is to first recognize that you are in fact pregnant and second to see the location of implantation by ultrasound or most dangerously while in the operating room. (3) The Emergency Medicine literature has recognized the following major risk factors for ectopic pregnancy: (4)

TABLE 98-3 Major Risk Factors for Ectopic Pregnancy
Pelvic inflammatory disease, history of sexually transmitted infections
History of tubal surgery or tubal sterilization
Conception with intrauterine device in place
Maternal age 35-44 (age-related change in tubal function)
Assisted reproduction techniques (cause unknown, as tube is bypassed in implantation)
Previous ectopic pregnancy
Cigarette smoking (may alter embryo tubal transport)
Prior pharmacologically induced abortion

The take home points on the topic of ectopic are that a woman must consider that if they feel unwell and have had sex, with or without protection or "contraception", diagnosing a pregnancy is very important in identifying what is wrong. A relevant male sexual partner could respectfully encourage the consideration of pregnancy in this setting. Ectopic pregnancy can only be further confirmed by a doctor in an office, urgent care center, or emergency department.

Image from Wikipedia on the topic





REFERENCES:

1. Ankum WM, Mol BW, Van der Veen F et al.: Risk factors for ectopic pregnancy: a meta-analysis. Fertil Steril 65: 1093, 1996.
2. Centers for Disease Control and Prevention: Ectopic pregnancy-United States, 1990-1992. JAMA 273: 533, 1995.
3. Johnstone C: Vaginal examination does not improve diagnostic accuracy in early pregnancy bleeding. Emerg Med Aust 25: 219, 2013.
4. Heaton HA. Ectopic Pregnancy and Emergencies in the First 20 Weeks of Pregnancy. In: Tintinalli JE, Stapczynski J, Ma O, Yealy DM, Meckler GD, Cline DM. eds. TABLE 98-3 Major Risk Factors for Ectopic Pregnancy Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 8e.New York, NY: McGraw-Hill; 2016.http://accessemergencymedicine.mhmedical.com/content.aspx?bookid=1658&Sectionid=109434141. Accessed October 20, 2016.





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