Ectopic pregnancy

Ectopic pregnancy typically presents 6 to 8 weeks after the last normal menstrual period, but can present earlier or later.

Risk of ectopic pregnancy increases with prior ectopic pregnancy, tubal surgery, history of sexually transmitted infections, smoking, in vitro fertilisation, or if the woman is pregnant despite IUD usage.

Classical symptoms and signs of ectopic pregnancy are pain, vaginal bleeding, and amenorrhoea. Haemodynamic instability and cervical motion tenderness may indicate rupture or imminent rupture of an ectopic pregnancy.

If the woman is haemodynamically stable, transvaginal ultrasound is the initial test of choice.

Treatment approaches for ectopic pregnancy include expectant, medical (methotrexate), or surgical (salpingectomy, salpingostomy).

If an ectopic pregnancy ruptures, the woman may present in shock from blood loss and with unusual patterns of referred pain from intraperitoneal blood.

An ectopic pregnancy occurs when a fertilised ovum implants and matures outside the uterine endometrial cavity, with the most common site being the fallopian tube (97%), followed by the ovary (3.2%) and the abdomen (1.3%).[1]Bouyer J, Coste J, Fernandez H, et al. Sites of ectopic pregnancy: a 10 year population-based study of 1800 cases. Hum Reprod. 2002 Dec;17(12):3224-30. https://academic.oup.com/humrep/article/17/12/3224/569616 http://www.ncbi.nlm.nih.gov/pubmed/12456628?tool=bestpractice.com If undiagnosed or untreated, it may lead to maternal death due to rupture of the implantation site and intraperitoneal haemorrhage.[2]Ankum WM, Mol BW, Van Der Veen F, et al. Risk factors for ectopic pregnancy: a meta-analysis. Fertil Steril. 1996 Jun;65(6):1093-9. http://www.ncbi.nlm.nih.gov/pubmed/8641479?tool=bestpractice.com