Assume female patients are pregnant
In female patients with abdominal pain, complications of pregnancy are an immediate concern. "The literature clearly shows that you can't predict which women of reproductive age are pregnant," says William Mallon, MD, FACEP, associate professor of emergency medicine at University of Southern California Medical Center in Los Angeles. "Two to 5% of women have unexpected pregnancy-including those who are on birth control pills, or even those who have had tubal ligation. So historical data suggesting they shouldn't be pregnant ought to be looked at somewhat askance."
Pregnancy testing across the board ought to be standard, Mallon argues. "No other test in women with abdominal pain will more quickly change your approach than a positive pregnancy test," says Mallon. "The most important thing with pelvic abdominal pain is making sure the patient is not pregnant. It's an ectopic until proven otherwise."
All women of childbearing potential with belly pain need a pregnancy, urine, and pelvic exam, says Stephen Colucciello, MD, FACEP, clinical services director and trauma coordinator for the department of emergency medicine at Carolinas Medical Center in Charlotte, NC, who created a protocol to ensure pregnancy tests are given at triage to women with abdominal pain (see protocol, page 163).
Even women on the Pill, those with tubal ligations, women who have not missed a period, and those using other forms of contraception need to be tested for pregnancy, urges Colucciello. "Even women who state they are not sexually active need a pregnancy test," he says. "I see at least 30 virgin births per year, and I am not even religious."
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