Diagnosing Failed Pregnancy in the ED — Can I Be Certain?

Sarah Klemencic


AccessMedicine from McGraw-Hill 

In This Article


Patients with pregnancy related complaints are seen on a daily basis in emergency departments (EDs) across America. Emergency physicians (EPs) must be able to distinguish between pregnancy failure, ectopic pregnancy and appropriate early pregnancy. Pelvic ultrasound combined with serum human chorionic gonadotropin (hCG) is the mainstay for diagnosis. Misdiagnosing an ectopic or very early normal pregnancy as a failed pregnancy clearly has unacceptable results for the affected patient. If the patient’s presentation is not life-threatening, the diagnostic dilemma becomes determining viable vs nonviable pregnancy, and determining the pregnancy location.[1]

The values and recommendations underlying current diagnostic guidelines were based on small studies with relatively low specificity, and utilized less technologically advanced ultrasound machines.[1,3] Thus, there are concerns that these guidelines may result in misdiagnosis of failed or early ectopic pregnancy in some cases of very early normal pregnancy. The authors of this NEJM article sought to provide updated guidelines to assist physicians in diagnosing nonviable pregnancy with nearly 100% specificity, and nearly 100% positive predictive value (PPV) to decrease false positive results.[1]