Ectopic pregnancy

Implantation of a fertilized ovum outside the uterus results in an ectopic pregnancy

A typical history is a female with a history of 6-8 weeks amenorrhoea who presents with lower abdominal pain and later develops vaginal bleeding

• lower abdominal pain: typically the first symptom. Pain is usually constant and may be unilateral. Due to tubal spasm
• vaginal bleeding: usually less than a normal period, may be dark brown in colour
• history of recent amenorrhoea: typically 6-8 weeks from start of last period; if longer (e.g. 10 wks) this suggest another causes e.g. inevitable abortion
• peritoneal bleeding can cause shoulder tip pain and pain on defecation / urination

Examination findings

• abdominal tenderness
• cervical excitation (also known as cervical motion tenderness)
• adnexal mass: NICE advise NOT to examine for an adnexal mass due to an increased risk of rupturing the pregnancy. A pelvic examination to check for cervical excitation is however recommended