Gravidez ectópica
Summary
Definition
History and exam
Key diagnostic factors
- dor abdominal
- amenorreia
- sangramento vaginal
- desconforto abdominal
- sensibilidade ou massa anexial
- sangue na cúpula vaginal
- instabilidade hemodinâmica, hipotensão ortostática
- dor à mobilização do colo
Other diagnostic factors
- desejo de defecar
- dor referida no ombro
Risk factors
- gravidez ectópica prévia
- cirurgia de esterilização tubária prévia
- exposição ao dietilestilbestrol no útero da mãe
- uso de dispositivo intrauterino (DIU)
- infecções genitais prévias
- salpingite crônica
- salpingite ístmica nodosa
- infertilidade
- múltiplos parceiros sexuais
- tabagismo
- raça/etnia
- tecnologia de reprodução assistida
- primeiro contato sexual <18 anos
- idade materna >35 anos
- cirurgia de reconstrução tubária
Diagnostic tests
1st tests to order
- teste de gravidez urinário ou sérico
- ultrassonografia transvaginal (USTV) de alta resolução
- ultrassonografia transabdominal
Tests to consider
- gonadotrofina coriônica humana (hCG) sérica serial
- aspiração uterina
Treatment algorithm
gravidez ectópica tubária: gravidez ectópica rota ou fracasso do tratamento clínico
gravidez ectópica tubária: risco moderado ou fracasso na conduta expectante
gravidez ectópica tubária: baixo risco
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
Disclosures
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 espontâneo
- Apendicite aguda
- Torção ovariana
More DifferentialsGuidelines
- Ectopic pregnancy and miscarriage: diagnosis and initial management
- ACR appropriateness criteria: acute pelvic pain in the reproductive age group
More GuidelinesPatient information
Gravidez ectópica: o que é?
Gravidez ectópica: quais são as opções de tratamento?
More Patient information
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