Last reviewed: November 2017
Last updated: May  2017

Summary

Definition

History and exam

Key diagnostic factors

  • abdominal pain
  • amenorrhea
  • vaginal bleeding
  • hemodynamic instability, orthostatic hypotension
  • abdominal tenderness
  • cervical motion tenderness
  • adnexal tenderness or mass
  • blood in vaginal vault

Other diagnostic factors

  • urge to defecate
  • referred shoulder pain

Risk factors

  • previous ectopic pregnancy
  • previous tubal sterilization surgery
  • in utero diethylstilbestrol exposure of the mother
  • intrauterine device (IUD) use
  • previous genital infections
  • chronic salpingitis
  • salpingitis isthmica nodosa
  • infertility
  • multiple sexual partners
  • smoking
  • in vitro fertilization (IVF)
  • first sexual encounter <18 years
  • maternal age >35 years
  • tubal reconstruction surgery
  • black race

Diagnostic investigations

1st investigations to order

  • urine pregnancy test
  • high-resolution transvaginal ultrasound (TVUS)
  • transabdominal ultrasound
Full details

Investigations to consider

  • serial blood hCG
  • serum progesterone
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Consultant Gynaecologist and Subspecialist in Reproductive Medicine

Nuffield Department of Obstetrics and Gynaecology

University of Oxford

John Radcliffe Hospital

Oxford

UK

Disclosures

IG declares that she has no competing interests.

Dr Ingrid Granne would like to gratefully acknowledge Dr Veronica Gomez-Lobo, Dr Sina Haeri, and Dr Mohammad Ezzati, previous contributors to this monograph. VGL, SH, and ME declare that they have no competing interests.

Peer reviewers VIEW ALL

Chief

Reproductive Biology Medicine and Biology

NICHD

Bethesda

MD

Disclosures

AD declares that he has no competing interests.

Consultant in Obstetrics and Gynaecology

West Middlesex University Hospital

London

UK

Disclosures

JCG declares that she has no competing interests.

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