Ectopic Pregnancy

Key Features

Lower Abdominal Pain and Tenderness
. Typically, the first symptom, which may be unilateral.
Missed Period
. Recent amenorrhea, indicating no menstruation for 6-8 weeks from the last period.
Vaginal Bleeding
. Often accompanies the other symptoms.
Shoulder Tip Pain and Peritonism
. Caused by peritoneal bleeding, indicating potential ectopic tubal rupture.
Cervical Motion Tenderness
. Also known as cervical excitation, a significant clinical sign.

Initial Investigation

Urine Pregnancy Test
. The first step in diagnosing a suspected ectopic pregnancy.

If Positive:
Transvaginal Ultrasound:
. Used to confirm the presence of an intrauterine pregnancy. If the uterus appears empty, further steps are required.

Further Investigation Based on Ultrasound Results

Hemodynamically Stable Patients:
. Check Beta-Human Chorionic Gonadotropin (β-hCG) Levels:
. If β-hCG < 1400 IU/L: Observation and repeat testing, as the pregnancy might be too early to detect via ultrasound.
. If β-hCG > 1400 IU/L: Laparoscopy to confirm and manage the ectopic pregnancy.

Hemodynamically Unstable Patients:
Urgent Laparotomy:
. Immediate surgical intervention (Open Salpingectomy or Salpingostomy) if the patient is hypotensive (SBP < 90) or showing signs of significant instability.

Management Options

Surgical:
. Laparoscopy is preferred for stable patients with a confirmed diagnosis of ectopic pregnancy.
. Laparotomy is used for unstable patients, focusing on stopping the bleeding and removing the ectopic tissue.

Medical:
. In selected stable patients with early ectopic pregnancies, Methotrexate can be administered to resolve the ectopic tissue without surgery.