Abdominal and pelvic findings are notoriously scant in many women before tubal rupture. Prior to rupture, the di-agnosis of an ectopic pregnancy is primarily based on labo-ratory and ultrasound findings. With rupture, however, nearly three-fourths of women will have marked tender-ness on both abdominal and pelvic examination, and pain is aggravated with cervical manipulation. A pelvic mass, in-cluding fullness posterolateral to the uterus, can be palpated in about 20% of women. Initially, the ectopic pregnancy may feel soft and elastic, whereas extensive hemorrhage produces a firmer consistency. Many times, discomfort pre-cludes palpation of the mass. Avoidance of pelvic examina-tions may actually help avert iatrogenic rupture.
Fever is not expected, although a mild elevation in temperature in response to intraperitoneal blood may occur. A temperature of 38°C may suggest an infectious cause to a patient’s symptoms. Abdominal distension and tenderness, with or without rebound, rigidity, or decreased bowel sounds, may be seen in cases of intra-abdominal bleeding. Abdominal tenderness is variable; it is present in 50% to 90% of patients with ectopic pregnancies. Cervical motion tenderness caused by intraperitoneal irritation and adnexal tenderness are commonly found. An adnexal mass is present in roughly one-third of cases, but its absence does not rule out the possibility of an ectopic implantation. The uterus may enlarge and soften throughout the first trimester, thus simulating an intrauterine pregnancy. A slightly open cervix with blood or decidual tissue may be found and mis-taken for a threatened and/or spontaneous abortion.
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