From the Guidelines
Ectopic pregnancy signs include a mass outside the ovary, positive serum hCG, and no sonographic evidence of an intrauterine pregnancy (IUP), as well as the presence of free intraperitoneal fluid with echoes, which is concerning for an ectopic pregnancy 1. The diagnosis of an ectopic pregnancy is generally based on positive findings, such as a mass outside the ovary, rather than solely on the absence of an IUP. Some key signs to look out for include:
- A mass outside the ovary, with no other obvious cause, in a patient with a positive serum hCG and no sonographic evidence of an IUP 1
- The presence of more than a normal small amount of free fluid or echoes within the fluid, even without identification of an extraovarian mass, which is concerning for an ectopic pregnancy 1
- Pelvic or abdominal pain, often one-sided, and vaginal bleeding, which can be symptoms of an ectopic pregnancy
- Shoulder pain, dizziness, or fainting, which can indicate internal bleeding It is essential to note that a minority of ectopic pregnancies occur in locations other than the fallopian tube, such as interstitial, cervical, or within a cesarean section scar, and that coexisting intrauterine and extrauterine pregnancy (heterotopic pregnancy) is rare but more likely to occur in women undergoing assisted reproduction techniques 1. In general, for a woman with a spontaneously occurring pregnancy, identification of an IUP excludes a coexisting ectopic pregnancy with near complete certainty, but the adnexa should still be routinely evaluated 1.
From the Research
Signs and Symptoms of Ectopic Pregnancy
- Vaginal bleeding, abdominal or pelvic pain, and amenorrhea are common presentations of ectopic pregnancy 2, 3, 4
- Abdominal pain is the most common symptom, followed by amenorrhea or vaginal bleeding, nausea, vomiting, syncope, and dizziness 4
- Referred shoulder pain following the onset of abdominal pain is characteristic of intraperitoneal bleeding and suggests a ruptured ectopic pregnancy 4
Diagnostic Evaluation
- Quantitative serum hCG, blood type, and ultrasound are necessary for evaluation 2
- Ultrasound is necessary regardless of the hCG level 2
- Serial ultrasonography and trends in beta human chorionic gonadotropin levels are used to make the diagnosis 3
- Pregnancy of unknown location (PUL) refers to a transient state in which a pregnancy test is positive but ultrasonography shows neither intrauterine nor ectopic pregnancy 2, 3
Risk Factors
- Risk factors for ectopic pregnancy include abnormalities of the fallopian tube, prior ectopic pregnancy, and age over 35 years 2
- Other risk factors include a history of pelvic inflammatory disease, cigarette smoking, fallopian tube surgery, previous ectopic pregnancy, and infertility 3, 4
- Current intrauterine device use and prior history of infertility are also risk factors 4