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Ectopic pregnancy is a diagnosis that is quite challenging to make. It has been estimated that 40% of ectopic pregnancies go undiagnosed on initial presentation. Ectopic pregnancy is also a very difficult condition to identify based on history and physical, with both the history and physical examination features being neither sensitive nor specific for the diagnosis. Data suggests that even experienced gynecologists are unable to detect more than half of the masses created by ectopic pregnancy on physical exam. Due to these nature of the condition, laboratory data and diagnostic imaging are essential components of diagnosing ectopic pregnancy. Ultrasonography is the diagnostic imaging study of choice for ectopic pregnancy. Even if an ectopic pregnancy cannot be visualized on ultrasound, diagnosing an intrauterine pregnancy greatly reduces the risk of an ectopic pregnancy being present. This activity reviews ectopic pregnancy and highlights the role of the interprofessional team in evaluating and treating patients with this condition. Objectives: Identify the indications for an ultrasound in a patient with abdominal pain. Describe the equipment and technique involved in performing a transvaginal ultrasound. Summarize the steps involved in performing a transabdominal ultrasound to rule out an ectopic pregnancy. Outline interprofessional team strategies for improving care coordination and communication to advance the diagnosis and management of ectopic pregnancies to improve patient outcomes. Access free multiple choice questions on this topic.

Ectopic pregnancy is a diagnosis that is quite challenging to make. It has been estimated that 40% of ectopic pregnancies go undiagnosed on initial presentation.[1] Ectopic pregnancy is also a very difficult condition to identify based on history and physical, with both the history and physical examination features being neither sensitive nor specific for the diagnosis. Data suggests that even experienced gynecologists are unable to detect more than half of the masses created by ectopic pregnancy on physical exam.[2] Due to the nature of the condition, laboratory data and diagnostic imaging are essential components of diagnosing ectopic pregnancy. Ultrasonography is the diagnostic imaging study of choice for ectopic pregnancy (see Image. Ectopic Pregnancy, Ultrasound). Even if an ectopic pregnancy cannot be visualized on ultrasound, diagnosing an intrauterine pregnancy greatly reduces the risk of an ectopic pregnancy being present. Two ultrasonographical approaches exist for the evaluation of ectopic pregnancy. The first is the less invasive transabdominal ultrasound, and the second is the more invasive but more diagnostic endovaginal ultrasonography.[3][4]

The diagnosis and management of an ectopic pregnancy is made by an interprofessional team that includes the emergency department physician, radiologist, obstetrician, and nurse practitioner. No patient should be discharged home if an ectopic is suspected. Ectopic pregnancies are a common gynecologic emergency that typically impacts otherwise healthy individuals and can have significant morbidity and mortality. Continued improvement in the ultrasonographic evaluation of these patients will aid in decreasing the mortality that continues to be associated with ruptured ectopic pregnancies.[8][9][10]

The initial action that is needed by the nurse at the time of patient presentation when there is a possibility of an ectopic pregnancy is to establish the patient safety net, consisting of obtaining a full set of vital signs, placing the patient on the monitor, and obtaining at least 1 large bore intravenous line. If the local nursing scope of practice includes drawing blood for labs, that will be needed as well for these patients. If the patient is stable, the next nursing action will be to hydrate the patient. The transabdominal portion of the ultrasound assessment is best performed with a full bladder. Oral hydration is able to help with this, but intravenous fluid administration is another option, depending on whether the patient is being allowed to take anything orally at that time. It is important to coordinate the hydration status with the provider performing the ultrasound, as it can be very uncomfortable for the patient if she is required to hold a full bladder for an extended time. After the diagnosis of an ectopic pregnancy is established, it will be important for the nurse to be a patient advocate.  The patient should be given mental support, and institutions may have support systems in place for mothers who have been diagnosed with a nonviable pregnancy.

Any patient with a suspected ectopic pregnancy needs to have a full set of vital signs on the initial presentation. Frequent reassessments of the blood pressure and heart rate are important to clue the team toward the development of shock from a ruptured ectopic pregnancy.