Ectopic Pregnancy

Symptoms: The most common clinical presentation of ectopic pregnancy is first-trimester vaginal bleeding and/or abdominal pain, lower abdominal tenderness, but can also be asymptomatic.

Management Steps: 

Confirm that the patient is pregnant with quantitative beta HCG test with repeat every 48 to 72 hrs to assess if pregnancy is progressing normally (increasing by ≥35 percent in 48 hours OR doubling in 72 hours) and with Transvaginal Ultrasound to attempt to confirm location of the foetus.  Low beta HCG may indicate ectopic pregnancy (or Down Syndrome foetus), usually in the fallopian tubes but documented in variety of body tissues.

Evaluate the patient for hemodynamic instability, since rupture of the structure in which the ectopic pregnancy is implanted may cause hemorrhage. Failure to diagnose ectopic pregnancy before tubal rupture limits the treatment options and increases maternal morbidity and mortality. Get CBC, blood type and screen if unknown.

Determine whether the pregnancy is intrauterine or ectopic (in rare cases, the pregnancy is heterotopic). Determine the site of the ectopic pregnancy.

Determine whether the structure in which the pregnancy is implanted (most commonly in the fallopian tube) or has ruptured and whether the patient is hemodynamically stable.

Perform additional testing to guide further management (eg, blood type and antibody screen, guidelines suggest pretreatment testing for methotrexate therapy, but this treatment modality has been judged inherently immoral in the case of an otherwise viable ectopy as it is the direct killing of a human life most famously by the Catholic Magisterium and by many other Christian and moral communities).

Risk Factors: prior ectopic pregnancy, current use of an intrauterine device, prior tubal ligation, and in vitro fertilization (IVF)