Ectopic%20pregnancy Signs and Symptoms

• 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

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

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