From the Guidelines
Vaginal bleeding occurs in approximately 50-80% of women with ectopic pregnancy, presenting as light spotting or irregular bleeding that differs from normal menstruation. This symptom is a result of the implanted embryo outside the uterus, most commonly in the fallopian tube, causing hormonal changes and local tissue damage as it grows 1. The bleeding is usually less heavy than a normal period because the endometrial lining may still partially shed due to falling progesterone levels when the ectopic pregnancy fails to properly support hormone production.
Key Points to Consider
- The presence of vaginal bleeding in ectopic pregnancy is not diagnostic on its own, as it can also occur in normal early pregnancy or miscarriage 1.
- Other symptoms like unilateral pelvic pain, shoulder pain, dizziness, or fainting—especially in combination with a positive pregnancy test—should prompt immediate medical evaluation to rule out this potentially life-threatening condition.
- The diagnosis of ectopic pregnancy involves careful evaluation of extrauterine locations for the pregnancy, identification of the ovaries and corpus luteum, and a careful search for any extraovarian mass that is not a paraovarian cyst or pedunculated fibroid 1.
- Visualization of an extrauterine gestational sac with a live embryo is 100% specific for an ectopic pregnancy, although this situation is uncommon 1.
- More common sonographic findings include an extrauterine mass with a fluid center and hyperechoic periphery, termed a tubal ring, or a nonspecific heterogeneous mass with no identifiable gestational sac within it 1.
From the Research
Frequency of Vaginal Bleeding in Ectopic Pregnancy
- Vaginal bleeding is a common symptom of ectopic pregnancy, with the classic triad of symptoms being lower abdominal pain, amenorrhoea, and vaginal bleeding 2.
- According to a study, the classic triad of lower abdominal pain, amenorrhoea, and vaginal bleeding was seen in 40.3% of cases of ectopic pregnancy 2.
- Another study mentions that vaginal haemorrhage is one of the classic symptoms of ectopic pregnancy, along with secondary amenorrhoea and abdominal pain 3.
- A case report of an abdominal ectopic pregnancy presents a woman with heavy vaginal bleeding and abdominal pain at 8 weeks' gestation 4.
- Ectopic pregnancy should be considered in any patient presenting early in pregnancy with vaginal bleeding or lower abdominal pain in whom intrauterine pregnancy has not yet been established 5.
Incidence of Vaginal Bleeding
- The incidence of vaginal bleeding in ectopic pregnancy is not explicitly stated in the provided studies, but it is mentioned as a common symptom 2, 3, 5.
- A study reports that 29 out of 72 cases of ectopic pregnancy presented with the classic triad of symptoms, including vaginal bleeding 2.
- However, the frequency of vaginal bleeding as a symptom of ectopic pregnancy is not quantified in the provided studies 6, 4, 3, 5.