Ectopic pregnancy
- Occurs in 1–2% of pregnancies
- 92–95% occurring in the fallopian tube
- Increasing trend of non-tubal ectopic pregnancy (i.e. interstitial (cornual), caesarean scar, cervical, heterotopic, ovarian and abdominal), especially caesarean scar pregnancy
- Failure to promptly diagnose and manage an ectopic pregnancy can be life threatening
- Responsible for 80% of maternal deaths in the first trimester
Risk Factors
- Sterilisation
- Previous ectopic pregnancy
- Previous tubal surgery
- Documented tubal pathology
- Previous genital infection confirmed
- Previous miscarriage
- Intrauterine device use more than 2 years
- Age 40 or older (compared to 25–29 years)
- Infertility (risk increases with length of)
- Current smoker (risk increases with amount/day)
- Smoking (past or ever)
Clinical presentation
- Absence of menses
- Irregular vaginal bleeding (spotting)—but not in all cases
- Abdominal pain, tenderness and palpable adnexal mass in 50% of women
- Cervical motion tenderness
- Absence of IUP on TVS with positive serum β-hCG
- Suspect a ruptured ectopic if:
- Shoulder tip or diaphragmatic pain (10–20% of ruptured ectopic)
- Tachycardia/hypotension from profound intraperitoneal haemorrhage
If medical or expectant:
- Risk of rupture in acute phase from sexual intercourse or pelvic exam
- Consider alternative management if indicated (e.g. β-hCG not falling, at woman’s request, tubal rupture or ongoing pain/bleeding)