Ectopic pregnancy

Last reviewed: 22 Aug 2023
Last updated: 20 Jun 2023



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
More key diagnostic factors

Other diagnostic factors

  • urge to defecate
  • referred shoulder pain
Other diagnostic factors

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
More risk factors

Diagnostic investigations

1st investigations to order

  • urine or serum pregnancy test
  • high-resolution transvaginal ultrasound (TVUS)
  • transabdominal ultrasound
More 1st investigations to order

Investigations to consider

  • serial serum human chorionic gonadotropin (hCG)
  • uterine aspiration
More investigations to consider

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



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




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


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.


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

Peer reviewers

Alan Decherney, MD


Reproductive Biology Medicine and Biology





AD declares that he has no competing interests.

Joanna C. Girling, MA, MRCP, FRCOG

Consultant in Obstetrics and Gynaecology

West Middlesex University Hospital




JCG declares that she has no competing interests.

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