Practice Essentials

Ectopic pregnancy is the result of a flaw in human reproductive physiology that allows the conceptus to implant and mature outside the endometrial cavity, which ultimately ends in the death of the fetus. Without timely diagnosis and treatment, ectopic pregnancy can become a lifethreatening situation.[1]

Essential update: Best modality for diagnosing ectopic pregnancy

In a systematic review of 14 studies with 12,101 patients, researchers found that the presence of an adnexal mass in the absence of an intrauterine pregnancy on transvaginal sonography had a positive likelihood ratio (LR+) of 111 for ectopic pregnancy, while the lack of adnexal abnormalities on transvaginal sonography decreases the likelihood of ectopic pregnancy. All components of the history had an LR+ of less than 1.5. Physical examination findings of cervical motion tenderness (LR+ 4.9), an adnexal mass (LR+ 2.8), and adnexal tenderness (LR+ 1.9) all increased the likelihood of ectopic pregnancy.[2, 3]

Signs and symptoms

The classic clinical triad of ectopic pregnancy is as follows:

Abdominal pain Amenorrhea Vaginal bleeding

Unfortunately, only about 50% of patients present with all 3 symptoms. Patients may present with other symptoms common to early pregnancy (eg, nausea, breast fullness). The following symptoms have also been reported:

Painful fetal movements (in the case of advanced abdominal pregnancy) Dizziness or weakness Fever Flulike symptoms Vomiting Syncope Cardiac arrest

The presence of the following signs suggests a surgical emergency:

Abdominal rigidity Involuntary guarding Severe tenderness Evidence of hypovolemic shock (eg, orthostatic blood pressure changes, tachycardia)

Findings on pelvic examination may include the following:

The uterus may be slightly enlarged and soft Uterine or cervical motion tenderness may suggest peritoneal inflammation An adnexal mass may be palpated but is usually difficult to differentiate from the ipsilateral ovary Uterine contents may be present in the vagina, due to shedding of endometrial lining stimulated by an ectopic pregnancy