Ectopic pregnancy
Summary
Definition
History and exam
Key diagnostic factors
- abdominal pain
- amenorrhea
- vaginal bleeding
- abdominal tenderness
- adnexal tenderness or mass
- blood in vaginal vault
- hemodynamic instability, orthostatic hypotension
- cervical motion tenderness
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
- race/ethnicity
- assisted reproductive technology (ART)
- first sexual encounter <18 years
- maternal age >35 years
- tubal reconstruction surgery
Diagnostic tests
1st tests to order
- urine or serum pregnancy test
- high-resolution transvaginal ultrasound (TVUS)
- transabdominal ultrasound
Tests to consider
- serial serum human chorionic gonadotropin (hCG)
- uterine aspiration
Treatment algorithm
tubal ectopic pregnancy: ruptured ectopic pregnancy or failed medical management
tubal ectopic pregnancy: moderate risk or failed expectant management
tubal ectopic pregnancy: low risk
Contributors
Authors
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
PA
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
MD
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
UK
Declarações
JCG declares that she has no competing interests.
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Referências
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
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-e55.Texto completo Resumo
Artigos de referência
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