Symptoms of Tubal Ectopic Pregnancy

SYMPTOMS

With the availability of early pregnancy testing, the ability to diagnose ectopic pregnancy before rupture—even before the onset of symptoms—is not unusual. The classic symp-toms associated with ectopic pregnancy are amenorrhea followed by vaginal bleeding and abdominal pain on the affected side. However, there is no constellation of symp-toms that are diagnostic. Other pregnancy discomforts, such as breast tenderness, nausea, and urinary frequency, may accompany more ominous findings. These include shoul-der pain worsened by inspiration, which is caused by phrenic nerve irritation from subdiaphragmatic blood, or vaso-motor disturbances such as vertigo and syncope from hem-orrhagic hypovolemia.

As long as placental hormones are produced, there is usually no vaginal bleeding. Irregular vaginal bleeding re-sults from the sloughing of the decidua from the endome-trial lining. Vaginal bleeding in patients with an ectopic gestation may range from little or none to heavy, menstrual-like flow. In some patients, the entire “decidual cast” is passed intact, simulating a spontaneous abortion. Histo-logic evaluation of this tissue confirms whether placental villi are present. In any patient with a positive pregnancy test result, whenever evaluation of tissue passed sponta-neously or obtained by curettage does not demonstrate villi, an ectopic implantation should be assumed to be pre-sent until proven otherwise.

Many women with a small unruptured ectopic preg-nancy may have unremarkable clinical findings. Neverthe-less, the diagnosis should be considered strongly when any of the above symptoms are reported by reproductive-age women, especially those with risk factors for an extrauter-ine pregnancy.