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 .
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