Last reviewed: October 2018
Last updated: October  2018

Summary

Definition

History and exam

Key diagnostic factors

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

Other diagnostic factors

  • urge to defecate
  • referred shoulder pain

Risk factors

  • previous ectopic pregnancy
  • previous tubal sterilisation 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
  • assisted reproductive technology (ART)
  • first sexual encounter <18 years
  • maternal age >35 years
  • tubal reconstruction surgery

Diagnostic investigations

1st investigations to order

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

Investigations to consider

  • serial serum hCG
  • uterine aspiration
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

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

Disclosures

KTB declares that he has no competing interests.

Dr Kurt T. Barnhart would like to gratefully acknowledge Dr Ingrid Granne, a previous contributor to this topic.

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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