Skip to Main Content

We have a new app!

Take the Access library with you wherever you go—easy access to books, videos, images, podcasts, personalized features, and more.

Download the Access App here: iOS and Android

  • • Severe abdominal tenderness with guarding

    • Hemodynamic instability

    • Adnexal mass


  • • Incidence has increased with the use of advanced reproductive technologies

    • At least 2 in every 100 pregnancies are ectopic

    • Mortality 0.3% in ectopic pregnancy

    • 95% of ectopic pregnancies occur in the uterine tube, usually in the ampullary portion

    • In vitro fertilization has increased the incidence of heterotopic pregnancy (intrauterine + ectopic)

    • Risk factors include:

    • -Prior ectopic pregnancy

      -History of pelvic inflammatory disease (PID)

      -Prior pelvic surgery

      -In vitro fertilization

      -Current intrauterine device use


      -Diethylstilbestrol exposure

      -Increasing age

Symptoms and Signs

  • • Sudden-onset lower abdominal pain with guarding

    • Lower back discomfort

    • Hemodynamic instability

    • Adnexal mass

    • Amenorrhea

    • Current or recent history of vaginal spotting/bleeding

Laboratory Findings

  • • Positive β-hCG

    • Lowered Hgb

    • Slight leukocytosis

    • Lower values of quantitative β-hCG for gestational age of fetus

    • Progesterone level < 5 ng/mL

Imaging Findings

  • • Transvaginal US is the radiographic procedure of choice

    • -Free fluid in the cul-de-sac

      -Absence of intrauterine gestational sac—especially when β-hCG level is > 2000 mIU/mL (a threshold value above which an intrauterine gestational sac should be detected)

      -Presence of adnexal mass

  • • Threatened spontaneous abortion

    • Missed abortion

    • Acute appendicitis

    • Acute PID

    • Ruptured corpus luteum cyst

    • Ureteral colic

    • Hemorrhagic ovarian cysts or tumors

    • Torsed ovarian cysts or tumor

Rule Out

  • • Threatened abortion

    • Missed abortion

  • • CBC

    • Basic chemistries

    • β-hCG

    • Serum progesterone

    • Prothrombin time and partial thromboplastin time

    • Transvaginal US

When to Admit

  • • Many uncomplicated ectopic pregnancies are diagnosed and managed in clinician's offices as an outpatient

    • All patients with a ruptured ectopic pregnancy should be admitted for urgent surgical exploration

When to Refer

  • • All patients with suspected ectopic pregnancy should be managed by a gynecology-trained surgeon

  • • Treatment is surgical

    • Goals are to control hemorrhage and preserve as much uterine tube as possible

    • Serial Hgb evaluation

    • Cross-matched blood on reserve

    • Determine Rh status



  • • All patients with ruptured ectopic pregnancy require immediate laparotomy

    • Laparoscopic approaches to nonruptured ectopic pregnancies are gaining popularity


  • • RH0(D) immune globulin to patients who are Rh negative

Treatment Monitoring

  • • β-hCG levels should return to normal values

    • Hgb stabilization


  • • Infertility

    • Repeat ectopic pregnancy


  • • 0.3% ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.