OUTCOME ANALYSIS OF A PROTOCOL INCLUDING BEDSIDE ENDOVAGINAL SONOGRAPHY IN PATIENTS AT RISK FOR ECTOPIC PREGNANCY

Study objectives: To determine whether bedside endovaginal sonography (EVS) performed by emergency physicians reduces complications associat ed with ectopic pregnancy (EPI including missed EP and EP rupture. Met hods: Our setting was an urban trauma center emergency department. We assembled a prospective convenience sample (n=314) with a historical E P control group (n=56) of women 18 years or older with a positive preg nancy test and any signs, sym ptoms, or risk factors for EP. Bedside E VS for all subjects and immediate quantitative serum human chorionic g onadotropin determination for patients with no definite intrauterine p regnancy by EVS. Results: Retrospective chart review identified 56 EP patients in the historical control group who had had no bedside EVS. T wenty-four of these patients (43%; 95% confidence interval [CI], 30% t o 56%) were discharged from the ED, 12 of whom (50%; 95% Cl, 30% to 70 %) were later categorized as having ruptured EP. During the prospectiv e study period, 40 patients were diagnosed as having EP; 11 (28%; 95% Cl, 14% to 42%) were discharged from the ED (P=NS), and only 1 (9%; 95 % Cl, 0% to 26%) of the discharged patients was later determined to ha ve a ruptured EP (P<.05). Conclusion: An EP protocol incorporating bed side EVS performed by emergency physicians significantly reduced the i ncidence of discharged patients with subsequent EP rupture, compared w ith historical controls.