Ectopic%20pregnancy Signs and Symptoms
Definition
- Any pregnancy in which the blastocyst implants outside the endometrial lining of the uterine cavity
- 90% are located in the fallopian tube while the rest are extratubal (eg abdominal, cervical, heterotopic, interstitial, ovarian, cornual or cesarean scar pregnancies)
Accurate early diagnosis is life-saving, reduces invasive diagnostic procedures and allows conservative treatment that can preserve fertility
- Ectopic pregnancy must be excluded in women of reproductive age with a positive pregnancy test, abdominal pain and vaginal bleeding
- Ruptured ectopic pregnancy remains to be the leading cause of maternal mortality in the 1st trimester
Signs and Symptoms
Clinical Presentation
- Abdominal pain and irregular bleeding are the most common presenting symptoms
- Bleeding is usually referred to as “spotting”, dark brown and may be intermittent or continuous
- Symptoms usually manifest 6-8 weeks after the last normal menstrual period
- Patient may also present with vertigo or syncope
- Other presentations will depend on the location of the ectopic pregnancy
- Eg pleuritic pain may result from irritation of the diaphragm by a large hemoperitoneum
- Clinical manifestations depend on whether the ectopic pregnancy has ruptured
- A ruptured ectopic pregnancy commonly presents with sudden onset of severe lower abdominal pain characterized as sharp, stabbing, or tearing
- Symptoms suggestive of intra-abdominal hemorrhage include syncope, hypotension, tender abdomen with guarding or rebound, and tenderness of adnexal mass on pelvic exam
Risk Factors
Risk Factors
Low to Moderate Risk
- Cigarette smoking
- Vaginal douching
- First intercourse <18 years old
- Infertility or infertility treatments
- History of chlamydial or gonococcal cervicitis
- Multiple sexual partners
- Salpingitis isthmica nodosa
High Risk
- History of pelvic inflammatory disease (PID)
- Previous tubal or pelvic surgery
- Tubal ligation
- Previous ectopic pregnancy
- In utero diethylstilbestrol (DES) exposure
- Current intrauterine device (IUD) use
- Documented tubal abnormality
- Assisted reproduction