From the Guidelines
Ectopic pregnancies typically do not generate uterine bleeding, but rather vaginal bleeding that differs from normal menstrual bleeding. This is because the implantation outside the uterus, most commonly in the fallopian tube, disrupts hormonal patterns that maintain the uterine lining, leading to shedding of parts of the endometrium and resulting in light to moderate vaginal bleeding 1. The bleeding in ectopic pregnancy is usually less heavy than a normal period and may be accompanied by one-sided pelvic pain, shoulder pain, or dizziness. Some key points to consider in the evaluation of ectopic pregnancy include:
- Assessment of any free intraperitoneal fluid, as echoes within the free fluid are often due to blood 1
- The presence of more than a normal small amount of free fluid or echoes within the fluid is concerning for an ectopic pregnancy, although this finding is not specific and can also occur for other reasons 1
- A minority of ectopic pregnancies occur in locations other than the fallopian tube, such as interstitial, cervical, or within a cesarean section scar, and may require additional evaluation with three-dimensional US 1
- Coexisting intrauterine and extrauterine pregnancy is rare, but more likely to occur in women undergoing assisted reproduction techniques, and identification of an IUP generally excludes a coexisting ectopic pregnancy with near complete certainty 1.
From the Research
Ectopic Pregnancy and Uterine Bleeding
- Ectopic pregnancy occurs when a fertilized ovum implants outside of the uterine cavity 2.
- Symptoms of ectopic pregnancy include vaginal bleeding or lower abdominal pain in early pregnancy, especially when intrauterine pregnancy has not been established 2, 3.
- Vaginal bleeding is a common symptom of ectopic pregnancy, and it is often associated with other symptoms such as abdominal pain 3, 4.
- The prevalence of ectopic pregnancy in women presenting with first-trimester bleeding, lower abdominal pain, or a combination of both is between 6% and 16% 4.
- Ectopic pregnancy can cause uterine bleeding due to the implantation of the fertilized ovum outside the uterine cavity, leading to bleeding or spotting 2, 5.
Diagnosis and Management
- Diagnosis of ectopic pregnancy is difficult due to non-specific symptoms, but it can be made using ultrasound imaging and β-human chorionic gonadotropin (β-hCG) monitoring 3.
- Treatment options for confirmed ectopic pregnancies include medical, surgical, and expectant management, depending on β-hCG levels, hematologic stability, and risk of ectopic pregnancy rupture 3, 4.
- Medical management with methotrexate is a common treatment option for ectopic pregnancy, while surgical management via salpingostomy or salpingectomy is also used in some cases 2, 6.
Complications and Morbidity
- Ectopic pregnancy can lead to acute complications such as rupture of the fallopian tube or ectopic pregnancy, hemorrhage, and hypovolaemic shock 5.
- Patients may experience ongoing morbidity, including chronic pain, infertility, and psychological distress after an ectopic pregnancy 5.
- Future fertility is an important aspect to consider in the management of ectopic pregnancy, and treatment options should be chosen with this in mind 5.