Ectopic Pregnancy

Question 1

What is the typical history of a female with an ectopic pregnancy?

Answer 1

• 6-8 weeks of amenorrhoea who first develops lower abdominal pain and then vaginal bleeding.

Question 2

What are the features of ectopic pregnancy?

Answer 2

• Lower abdominal pain: typically the first symptom. Pain is usually constant and may be unilateral. Due to tubal spasm
• Vaginal bleeding: usually less than a normal period, may be dark brown in colour
• History of recent amenorrhoea: typically 6-8 weeks from start of last period; if longer (e.g. 10 wks) this suggest another causes e.g. inevitable abortion
• Peritoneal bleeding can cause shoulder tip pain and pain on defecation / urination

Question 3

The patient will often have abdominal tenderness, but should you examine for cervical excitation (cervical motion tenderness) and should you examine for an adenxal mass?

Answer 3

You should examine for cervical excitation.

But DO NOT examine for an adnexal mass due to risk of rupturing the pregnancy.