The EM Educator Series: Controversial Elements of Ectopic Pregnancy

Author: Alex Koyfman, MD (@EMHighAK) // Edited by: Brit Long, MD (@long_brit) and Manpreet Singh, MD (@MprizzleER)

Welcome back to the EM Educator Series. These posts provide brief mini-cases followed by key questions to consider while working. The featured questions provide important learning points for those working with you, as well as vital items to consider in the evaluation and management of the specific condition discussed.

This week has another downloadable PDF document with questions, links and answers you can share with learners as educators in #MedEd. Please message us over Twitter and let us know if you have any feedback on ways to improve this for you. Enjoy!

A 24-year-old female presents with abdominal pain and nausea. She is 9 weeks pregnant by dates. She has noted some spotting, but no severe bleeding. VS include HR 122, BP 87/42, RR 22, Sats 98% RA, and T 98 oral. Her abdomen is diffusely tender, and she appears ill. Her pregnancy test is positive, and US reveals a right-sided adnexal mass, with free fluid in the pelvis.


  1. What are the risk factors for ectopic pregnancy?
  2. How can patients with ectopic pregnancy present?
  3. What is the ED work-up?
  4. For the crashing patient with ectopic pregnancy, what’s the management, and who can help?
  5. What are other types of ectopic pregnancy: cervical ectopic, interstitial ectopic, heterotopic? How can these be challenging?
  6. How can the hCG fool you? What about following hCG trends?
  7. When is an ultrasound needed, and how can this fool you?
  8. What are pitfalls of medical management with methotrexate?


From Dr. Hanson at Hanson’s Anatomy:

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