CLINICAL

PRESENTATION

OF ECTOPIC

PREGNANCY

SRINIVASAN. G,

2009.

Clinical Presentation

It occurs about 7 weeks after the last normal

menstrual period.

Compared to the other forms of early pregnancy

disorders, there is no pathognomonic pain or findings

on clinical examination that are diagnostic of a

developing extra uterine pregnancy.

Vaginal bleeding (usually old blood in small amounts)

and chronic pelvic pain (iliac fossa, sometimes

bilateral) are the most commonly reported symptoms.

Common symptoms

Abdominal or Pelvic pain

Amenorrhoea or missed periods

Vaginal Bleeding with or without clots.

SYMPTOMS

PAIN

Most frequently experience symptom.

Pelvic and abdominal pain.

With more advance gestation, presents with

gastrointestinal symptoms and dizziness or light headache.

With rupture, pain may be anywhere in abdomen.

Pleuritic chest pain – from diaphragmatic irritation caused by the hemorrhage

Abnormal menstruation

Most women experience amenorrhea.

However 1/4th mistakes the uterine bleeding

occurs as true menstruation.

Profuse vaginal bleeding is rare.

Other Symptoms

Dizziness, Fainting or syncope

Shoulder Tip pain.

Urinary symptoms.

Passage of tissue.

Pain on defecation

Abdominal & pelvic tenderness

It is demonstrable in three fourths of the ruptured and

rupturing tubal pregnancies.

It may be absent in Unruptured pregnancies.

Signs

Uterine changes

Uterus pushed to one side by an ectopic mass.

In 25% of women uterus enlarges due to hormonal

stimulation.

Uterine decidua without trophoblast suggests ectopic

pregnancy but not absolutely & absence of decidual

tissue does not exclude it.

BP & Pulse

Before rupture: vital signs are normal.

Moderate Hemorrage: A vasovagal response with

bradycardia and hypotension.

Full-blown rupture:

• Tachycardia (pulse rate more than 100/min) or

• Systolic BP less than 100mmhg.

If bleeding continues, BP will fall and

Pulse will rise.

• Hypovolemia and shock- profuse bleeding have occurred.

Other Signs

Cervical motion tenderness

Rebound tenderness or peritoneal signs.

Pallor

Abdominal Distension.

Orthostatic Hypertension.

Rupture of ectopic pregnancy

CLINICAL SIGNS OF ECTOPIC

THAT HAS RUPTURED

Severe one-sided lower abdominal pain

Fainting and\or dizziness

Right shoulder pain

Signs of hypovolemic shock

Pelvic mass

On bimanual examination, pelvic mass of

size from 5 to 15cm can be seen.

Mass is almost either posterior or lateral to

the uterus.

Soft and elastic.

Culdocentesis

Simple technique to identify hemoperitoneum

Cervix is pulled toward the symphysis with a tenaculum

and a long 16 or 18 gauge needle is inserted through

the posterior fornix into the cul-de-sac.

Fluid containing fragments of old clots or bloody fluid

that does not clot is compatible with the diagnosis of

hemoperitoneum resulting from an ectopic pregnancy .