0:01

So what should our framework for interpreting these be?

0:05

And we are gonna base that on two main questions.

0:11

So when we are presented with this clinical history,

0:14

as we mentioned, it often is written as rule out ectopic

0:18

and ruling out ectopic is certainly important.

0:22

However, if a patient arrives in the emergency room bleeding

0:27

and crashing from a ruptured ectopic pregnancy,

0:31

then they basically need to go straight to the

0:33

or you could argue without even getting an ultrasound,

0:36

although most people would in this day and age.

0:40

And assuming though that that's not the case,

0:43

they're not crashing.

0:45

The question we, we really need to keep in the forefront

0:48

of our minds is, is there a chance

0:52

that this is a viable pregnancy?

0:55

And if that is the case, then we need to stop

0:59

and think about the whole gamut of,

1:04

of possibilities in a very specific way.

1:07

As a quick aside, you know, we're gonna assume

1:10

that these patients are patients who are desiring

1:13

to continue their pregnancy.

1:14

If someone comes in and they didn't wanna be pregnant

1:17

and they don't wanna be pregnant

1:19

and they don't want to continue with their pregnancy,

1:21

then evacuating the uterus

1:23

or doing a therapeutic abortion is off,

1:25

obviously always on the table.

1:26

But for the purposes of this lecture,

1:28

we're gonna assume this person actually wants to be pregnant

1:32

and continue with a pregnancy if it's viable.

1:36

So again, is there a chance of a viable pregnancy?

1:41

And then the next two follow-up questions are then

1:45

is it safe to evacuate the uterus?

1:47

And we'll talk about that,

1:48

but not, we're saying that you should evacuate the uterus

1:52

or do a therapeutic abortion, but it's safe too.

1:56

And then the other question would be, is it safe to treat

2:00

for an ectopic pregnancy?

2:02

So I'm putting this history of just first trimester bleeding

2:07

and pain, because that's what we see.

2:09

So the patient goes to get an ultrasound, and

2:12

after that ultrasound there are basically

2:15

five possible outcomes.

2:18

And we can look at what we need to do in the setting with,

2:21

with these questions in mind.

2:24

So we could diagnose an intrauterine pregnancy,

2:29

in which case we're gonna ask our questions.

2:32

It's clearly not safe to evacuate the uterus,

2:36

and we wouldn't wanna treat for an ectopic.

2:39

We could diagnose a definite pregnancy failure,

2:43

in which case, yes, it would be safe to evacuate the uterus.

2:47

Again, not saying we need to, but it would be safe to.

2:51

And then we know it's intrauterine,

2:53

but we're not sure if it's alive or not.

2:54

And we'll call that a pregnancy of uncertain viability. And

2:58

We'll get into what that means a little later.

3:01

But again, would not be safe

3:03

to evacuate the uterus in that situation.

3:07

We can diagnose a definite ectopic pregnancy,

3:11

in which case if it's definitely ectopic, it would be safe

3:14

to treat for an ectopic.

3:16

And then sometimes we just don't find a

3:19

pregnancy, but they're pregnant.

3:21

And we will call that a pregnancy of unknown location

3:24

and we'll get a little more into that later.

3:27

You might see an elevated HCG,

3:31

in which case you might think is it, it's safe to treat

3:34

for ectopic, but I'm gonna put a little yellow light there

3:37

because we're not sure.

3:39

And if the HCG is low, then it will not be safe

3:44

to treat for ectopic for sure.

3:46

So this is the framework that we're gonna dive into.

3:50

You know, much more you granularly throughout this topic.