Ectopic Pregnancy

An ectopic pregnancy occurs where a fertilized ovum is implanted in any tissue other than the uterine endometrium. The Royal College of Obstetricians and Gynaecologists estimate that the rate of ectopic pregnancy is 11.1 in 1000. The image below shows the potential sites of an ectopic pregnancy.

Patients presenting with abdominal pain and/or vaginal bleeding and a positive urinary βhCG in early pregnancy should be considered to have an ectopic pregnancy until proven otherwise.

Special note: Cornual implantation

Patients with cornual implantation may rupture after 12 weeks with catastrophic blood loss. These patients sometimes present with symptoms of gastroenteritis.

No single sign or combination of signs is diagnostic. Half of identified ectopics are in women with no known risk factors.

Risk factors for ectopic pregnancy include:

• Previous ectopic pregnancy – the risk of recurrence of ectopic pregnancy is about 18.5%.         
• History of pelvic inflammatory disease.
• Previous pelvic surgery (including sterilization [rare], tubal reconstruction surgery, caesarean section).
• Black ethnicity – black women are at increased risk compared to white women. 
• Assisted reproduction techniques, especially in vitro fertilization.
• Cigarette smoking.
• Maternal age over 35 years
• Intrauterine contraception (IUC) – the overall risk of ectopic pregnancy when using IUC is reduced compared to using no contraception. However, if pregnancy does occur with IUC in situ, the risk of an ectopic pregnancy is increased and, in some studies, half of pregnancies that occurred were ectopic.

No single sign or combination of signs is diagnostic. Half of identified ectopics is in women with no known risk factors.

On assessment THINK ECTOPIC for patients with a uterus of childbearing age who present with:

• Abdominal or pelvic pain
• Shoulder tip pain
• Collapse/syncope/faint
• Diarrhoea/ GI upset
• UTI symptoms
• Changes in menstrual cycle
• PV Bleeding
• Rectal pressure

Do a pregnancy test for all patients with a uterus of childbearing age who present with the above. [10]