Resumen
Definición
Anamnesis y examen
Principales factores de diagnóstico
- dolor abdominal
- amenorrea
- sangrado vaginal
- abdomen doloroso a la palpación
- dolor anexial a la palpación o masa
- sangre en la cúpula vaginal
- inestabilidad hemodinámica, hipotensión ortostática
- dolor al movimiento cervical
Otros factores de diagnóstico
- necesidad imperiosa de defecar
- dolor referido de hombro
Factores de riesgo
- embarazo ectópico previo
- cirugía de esterilización tubárica previa
- exposición al dietilestilbestrol en el útero de la madre
- uso de un dispositivo intrauterino (DIU)
- infecciones genitales previas
- salpingitis crónica
- salpingitis ístmica nodosa
- infertilidad
- múltiples parejas sexuales
- tabaquismo
- raza/etnia
- tecnología de reproducción asistida (TRA)
- primer encuentro sexual <18 años
- edad materna >35 años
- cirugía de reconstrucción tubárica
Pruebas diagnósticas
Primeras pruebas diagnósticas para solicitar
- prueba de embarazo en orina o suero
- ETV de alta resolución
- ecografía de abdomen
Pruebas diagnósticas que deben considerarse
- gonadotropina coriónica humana (hCG) en suero
- aspiración uterina
Algoritmo de tratamiento
embarazo ectópico tubárico: rotura de embarazo ectópico o fallo del manejo médico
embarazo ectópico tubárico: riesgo moderado o fracaso del manejo expectante
embarazo ectópico tubárico: bajo riesgo
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
PA
Divulgaciones
KTB is a co-author on several papers cited in this topic.
Acknowledgements
Dr Kurt T. Barnhart would like to gratefully acknowledge Dr Ingrid Granne, Dr Veronica Gomez-Lobo, Dr Sina Haeri, and Dr Mohammad Ezzati, previous contributors to this topic.
Disclosures
IG, VGL, SH, and ME declare that they have no competing interests.
Peer reviewers
Alan Decherney, MD
Chief
Reproductive Biology Medicine and Biology
NICHD
Bethesda
MD
Disclosures
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
Disclosures
JCG declares that she has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
ACOG practice bulletin no. 193: tubal ectopic pregnancy. Obstet Gynecol. 2018 Mar;131(3):e91-103. Abstract
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.Full text Abstract
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.Full text Abstract
National Institute for Health and Care Excellence. Ectopic pregnancy and miscarriage: diagnosis and initial management. Nov 2021 [internet publication].Full text
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Aborto espontáneo
- Apendicitis aguda
- Torsión ovárica
More DifferentialsGuidelines
- Ectopic pregnancy and miscarriage: diagnosis and initial management
- ACR appropriateness criteria: acute pelvic pain in the reproductive age group
More GuidelinesPatient information
Embarazo ectópico: ¿qué tratamientos funcionan?
More Patient information
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