Ectopic pregnancy

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 22 Jul 2025

Last updated: 14 Aug 2024

Ectopic pregnancy typically presents 6 to 8 weeks after the last normal menstrual period, but can present earlier or later.

Risk of ectopic pregnancy increases with prior ectopic pregnancy, tubal surgery, history of sexually transmitted infections, smoking, in vitro fertilization, or if the woman is pregnant despite IUD usage.

Classic symptoms and signs of ectopic pregnancy are pain, vaginal bleeding, and amenorrhea. Hemodynamic instability and cervical motion tenderness may indicate rupture or imminent rupture of an ectopic pregnancy.

If the woman is hemodynamically stable, transvaginal ultrasound is the initial test of choice.

Treatment approaches for ectopic pregnancy include expectant, medical (methotrexate), or surgical (salpingectomy or salpingostomy).

If an ectopic pregnancy ruptures, the woman may present in shock from blood loss and with unusual patterns of referred pain from intraperitoneal blood.

Definição

An ectopic pregnancy occurs when a fertilized ovum implants and matures outside the uterine endometrial cavity, with the most common site being the fallopian tube (97%), followed by the ovary (3.2%) and the abdomen (1.3%).[1] If undiagnosed or untreated, it may lead to maternal death due to rupture of the implantation site and intraperitoneal hemorrhage.[2]

História e exame físico

Principais fatores diagnósticos

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

Detalhes completos

Outros fatores diagnósticos

urge to defecate
referred shoulder pain

Detalhes completos

Fatores de risco

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
race/ethnicity
assisted reproductive technology (ART)
first sexual encounter <18 years
maternal age >35 years
tubal reconstruction surgery

Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

urine or serum pregnancy test
high-resolution transvaginal ultrasound (TVUS)
transabdominal ultrasound

Detalhes completos

Investigações a serem consideradas

serial serum human chorionic gonadotropin (hCG)
uterine aspiration

Detalhes completos

Algoritmo de tratamento

AGUDA

tubal ectopic pregnancy: ruptured ectopic pregnancy or failed medical management

tubal ectopic pregnancy: moderate risk or failed expectant management

tubal ectopic pregnancy: low risk

Colaboradores

Autores

Kurt T. Barnhart, MD, MSCE

William Shippen Jr. Professor of Obstetrics and Gynecology and Epidemiology

Vice Chair for Clinical Research

Director, Women's Health Clinic Research Center

The Perelman School of Medicine

University of Pennsylvania

Associate Chief, Penn Fertility Care

Philadelphia

Declarações

KTB is a co-author on several papers cited in this topic.

Agradecimentos

Dr Kurt T. Barnhart would like to gratefully acknowledge Dr Ingrid Granne, Veronica Gomez-Lobo, Dr Sina Haeri, and Dr Mohammad Ezzati, previous contributors to this topic.

Declarações

IG, VGL, SH, and ME declare that they have no competing interests.

Revisores

Alan Decherney, MD

Chief

Reproductive Biology Medicine and Biology

NICHD

Bethesda

Declarações

AD declares that he has no competing interests.

Joanna C. Girling, MA, MRCP, FRCOG

Consultant in Obstetrics and Gynaecology

West Middlesex University Hospital

London

Declarações

JCG declares that she has no competing interests.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

ACOG practice bulletin no. 193: tubal ectopic pregnancy. Obstet Gynecol. 2018 Mar;131(3):e91-103. Resumo

Kirk E, Bottomley C, Bourne T. Diagnosing ectopic pregnancy and current concepts in the management of pregnancy of unknown location. Hum Reprod Update. 2014 Mar-Apr;20(2):250-61.Texto completo Resumo

Elson CJ, Salim R, Potdar N, et al; Royal College of Obstetricians and Gynaecologists. Diagnosis and management of ectopic pregnancy: Green-top Guideline No. 21. BJOG. 2016 Dec;123(13):e15-55.Texto completo Resumo

National Institute for Health and Care Excellence. Ectopic pregnancy and miscarriage: diagnosis and initial management. Nov 2021 [internet publication].Texto completo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais
- Miscarriage
- Acute appendicitis
- Ovarian torsion
Mais Diagnósticos diferenciais
Diretrizes
- ACR appropriateness criteria: acute pelvic pain in the reproductive age group
- Ectopic pregnancy and miscarriage: diagnosis and initial management
Mais Diretrizes
Folhetos informativos para os pacientes
Ectopic pregnancy: what is it?
Ectopic pregnancy: what treatments work?
Mais Folhetos informativos para os pacientes
Conectar-se ou assinar para acessar todo o BMJ Best Practice

O uso deste conteúdo está sujeito ao nosso aviso legal

Ectopic pregnancy

Summary

Definição

História e exame físico

Principais fatores diagnósticos

Outros fatores diagnósticos

Fatores de risco

Investigações diagnósticas

Primeiras investigações a serem solicitadas

Investigações a serem consideradas

Algoritmo de tratamento

tubal ectopic pregnancy: ruptured ectopic pregnancy or failed medical management

tubal ectopic pregnancy: moderate risk or failed expectant management

tubal ectopic pregnancy: low risk

Colaboradores

Autores

Kurt T. Barnhart, MD, MSCE

Declarações

Agradecimentos

Declarações

Revisores

Alan Decherney, MD

Declarações

Joanna C. Girling, MA, MRCP, FRCOG

Declarações

Referências

Principais artigos

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais

Diretrizes

Folhetos informativos para os pacientes

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se para acessar todo o BMJ Best Practice