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Purpose <p>Ectopic pregnancy is the leading cause of maternal mortality in the first trimester of pregnancy [Marion and Meeks in Clin Obstet Gynecol 55:376–86, 2012, Ranji et al. in J Obstet Gynaecol India 68:487–92, 2018], with many symptomatic patients presenting to the emergency department (ED) for diagnosis and treatment. Access to diagnostic ultrasound is limited, with many patients requiring return visits during daytime hours. This study assessed outcomes associated with delayed diagnostic ultrasound for ectopic pregnancy.</p> Methods <p>Health records were reviewed to identify patients diagnosed with ectopic pregnancy in our tertiary-care ED from 2017 to 2023. The primary predictor variable was time from physician assessment to diagnostic ultrasound. Patients were excluded if they received a diagnostic ultrasound at another facility and were transferred for direct assessment by Obstetrics/Gynecology. Participants were classified based on visit status (daytime versus overnight/return visit) and time between physician assessment and diagnostic ultrasound. Outcome metrics including mortality, rupture, shock index, transfusion requirement, and rate of admission and operative management were analyzed using linear and logistic regression.</p> Results <p>A total of 140 patients were included. The majority had a point-of-care ultrasound (PoCUS) documented on their index visit (60%), and a minority of patients (32.8%) received a delayed diagnostic ultrasound the following day. Patients receiving a diagnostic ultrasound on their index visit were more likely to be diagnosed with a ruptured ectopic, require blood transfusion, admission, and surgical management. There were no recorded deaths related to ectopic pregnancy.</p> Conclusions <p>Although 24/7 access to diagnostic ultrasound should be available in tertiary-care centers, this study suggests there were no poor patient outcomes related to the delay in access. However, more than a third of discharged patients were subsequently admitted or needed surgical management after imaging on their return visit. Improved ultrasound access would avoid this repeat ED visit, enhancing patient-centered care and reducing unnecessary ED visits.</p>

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Ectopic pregnancy outcomes in the emergency department: a review of delays to diagnostic ultrasound

  • 期刊论文

  • 发表日期：

    2026年3月30日

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  • Alysha Roberts,
  • Michael Butler,
  • Mary-Lynn Watson

摘要

Purpose

Ectopic pregnancy is the leading cause of maternal mortality in the first trimester of pregnancy [Marion and Meeks in Clin Obstet Gynecol 55:376–86, 2012, Ranji et al. in J Obstet Gynaecol India 68:487–92, 2018], with many symptomatic patients presenting to the emergency department (ED) for diagnosis and treatment. Access to diagnostic ultrasound is limited, with many patients requiring return visits during daytime hours. This study assessed outcomes associated with delayed diagnostic ultrasound for ectopic pregnancy.

Methods

Health records were reviewed to identify patients diagnosed with ectopic pregnancy in our tertiary-care ED from 2017 to 2023. The primary predictor variable was time from physician assessment to diagnostic ultrasound. Patients were excluded if they received a diagnostic ultrasound at another facility and were transferred for direct assessment by Obstetrics/Gynecology. Participants were classified based on visit status (daytime versus overnight/return visit) and time between physician assessment and diagnostic ultrasound. Outcome metrics including mortality, rupture, shock index, transfusion requirement, and rate of admission and operative management were analyzed using linear and logistic regression.

Results

A total of 140 patients were included. The majority had a point-of-care ultrasound (PoCUS) documented on their index visit (60%), and a minority of patients (32.8%) received a delayed diagnostic ultrasound the following day. Patients receiving a diagnostic ultrasound on their index visit were more likely to be diagnosed with a ruptured ectopic, require blood transfusion, admission, and surgical management. There were no recorded deaths related to ectopic pregnancy.

Conclusions

Although 24/7 access to diagnostic ultrasound should be available in tertiary-care centers, this study suggests there were no poor patient outcomes related to the delay in access. However, more than a third of discharged patients were subsequently admitted or needed surgical management after imaging on their return visit. Improved ultrasound access would avoid this repeat ED visit, enhancing patient-centered care and reducing unnecessary ED visits.