An ectopic pregnancy is a pregnancy that implants outside the uterus, most often in a fallopian tube. As it grows the tube can rupture and cause life-threatening internal bleeding, so any pregnant person with pain or bleeding needs it ruled out.
Key symptoms
- Missed period or a known early pregnancy
- Lower belly or pelvic pain, often on one side
- Vaginal spotting or bleeding
- Shoulder tip pain from blood under the diaphragm
- Dizziness or fainting
What you find on exam
- Heart rate and blood pressure; look for signs of shock
- Belly tenderness, guarding or distension
- Pelvic exam: cervical motion tenderness, tender adnexal mass
- Amount of vaginal bleeding
Tests
- Urine or serum pregnancy test in every person of childbearing age with belly pain
- Quantitative beta-hCG, repeated after 48 hours if unclear
- Transvaginal ultrasound: no pregnancy in the uterus, adnexal mass, free fluid
- Blood count, blood type and Rh, crossmatch if unstable
- FAST ultrasound for blood in the belly if unstable
Treatment basics
- Unstable: two large IV lines, fluids, blood and emergency surgery
- Stable with a small ectopic and low hCG: methotrexate with follow-up of hCG levels
- Laparoscopic surgery when medication is not suitable
- Rh immune globulin if the patient is Rh negative
- Emotional support and teaching about warning signs
Red flags
- Fainting, fast pulse or low blood pressure
- Severe belly pain or shoulder tip pain
- Pregnancy test positive with no pregnancy seen in the uterus
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; NASEMSO National Model EMS Clinical Guidelines. Written by Making Synapses. Making Synapses is not affiliated with these organizations.