The diagnosis of (ectopic pregnancy) EP is among the most challenging for the emergency physician. Significant morbidity and mortality may result from a missed or delayed diagnosis. (See Chap 100 for a detailed discussion of ectopic pregnancy.) About half of all ectopic pregnancies are missed on first presentation to the ED. 38
The use of protocols that rule out ectopic pregnancy incorporating transvaginal pelvic sonography and the bhCG discriminatory zone, can decrease the rate of missed ectopic pregnancies.2,39
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