After a needle is advanced through the posterior vaginal wall into the peritoneal space, obtaining more than 2 ml of nonclotting blood suggests the presence of hemoperitoneum and ruptured EP. Management options for patients with suspected or confirmed EP include expectant management, medical therapy, or operative intervention. OB-GYN should be consulted expeditiously as these patients will require surgical intervention.
Stable patients with EP may be managed medically with methotrexate. Medical management may preserve future fertility better than surgery. This agent interferes with DNA synthesis and replication of fetal cells, resulting in involution of the pregnancy. Methotrexate may be considered in hemodynamically stable patients:. Abdominal pain is not uncommon days after methotrexate administration and must be differentiated from pain associated with ruptured EP.
Patients who cannot receive or fail methotrexate therapy require laparoscopy. Patients with pregnancy of unknown location i. All patients with concern for EP who are discharged from the ED should receive instructions to return for evaluation if worsening pain, vaginal bleeding, dizziness, syncope, or weakness develops. Case Resolution: The patient is given morphine and ondansetron with good resolution in her symptoms.
Her EKG is normal. A bedside ultrasound demonstrates gallstones with a normal-appearing gallbladder without wall thickening, pericholecystic fluid, or dilated common bile duct. Her liver function tests, white blood cell count, and lipase are normal. Her urine pregnancy test and urine analysis are similarly normal.
After an hour of observation she tolerates food without significant pain and her abdominal examination is benign. She is discharged home with strict return precautions and an outpatient referral to general surgery to discuss elective cholecystectomy for symptomatic cholelithiasis.
Clinical Policy: Critical issues in the initial evaluation and management of patients presenting to the emergency department in early pregnancy. Ann Emerg Med. PMID: Diagnosis and management of ectopic pregnancy using bedside transvaginal ultrasonography in the ED: a 2-year experience. Am J Emerg Med. Clinical diagnosis and treatment of ectopic pregnancy. Obstet Gynecol Surv. The more you smoke, the higher the risk. Experts suspect that smoking affects fallopian tube function.
A history of pelvic inflammatory disease PID , often caused by chlamydia or gonorrhea. Exposure to the chemical DES diethylstilbestrol before you were born. Medical treatments and procedures that can increase your risk of having an ectopic pregnancy include: Previous fallopian tube surgery to treat infertility or to reverse a tubal ligation.
A tubal ligation failure. In rare cases when pregnancy happens after a sterilization surgery, there is a higher-than-usual risk that the pregnancy is ectopic. A progestin-only birth control failure, such as progestin-only pills, or a pregnancy that happens with an intrauterine device IUD in place. This may result from the passing of the fertilized egg into a fallopian tube after it is transferred to the uterus.
Infection after any kind of surgery done on the uterus or fallopian tubes. This can lead to scar tissue. When should you call your doctor? Call or other emergency services immediately if: You passed out lost consciousness.
You have severe vaginal bleeding. You have sudden, severe pain in your belly or pelvis. Call your doctor now or seek immediate medical care if: You are dizzy or light-headed, or you feel like you may faint.
You have vaginal bleeding. You have new cramps or new pain in your belly or pelvis. You have new pain in your shoulder. Who to see Your family doctor , general practitioner , or an emergency medicine specialist can check you for an ectopic pregnancy. Examinations and Tests Most ectopic pregnancies can be detected using a pelvic examination, ultrasound, and blood tests. If you have symptoms of a possible ectopic pregnancy, you will have: A pelvic examination, which can detect tenderness in the uterus or fallopian tubes, less enlargement of the uterus than expected for a pregnancy, or a mass in the pelvic area.
A pelvic ultrasound transvaginal or abdominal , which uses sound waves to produce a picture of the organs and structures in the lower abdomen. A transvaginal ultrasound is used to show where a pregnancy is located. A pregnancy in the uterus is visible 6 weeks after the last menstrual period.
An ectopic pregnancy is likely if there are no signs of an embryo or fetus in the uterus as expected, but hCG levels are elevated or rising. Two or more blood tests of pregnancy hormone human chorionic gonadotropin, or hCG levels, taken 48 hours apart.
During the early weeks of a normal pregnancy, hCG levels double every 2 days. Low or slowly increasing levels of hCG in the blood suggest an early abnormal pregnancy, such as an ectopic pregnancy or a miscarriage. If hCG levels are abnormally low, further testing is done to find the cause. Follow-up testing after treatment During the week after treatment for an ectopic pregnancy, your hCG human chorionic gonadotropin blood levels are tested several times.
What to think about If you become pregnant and are at high risk for an ectopic pregnancy , you will be closely watched. Treatment Overview In most cases, an ectopic pregnancy is treated right away to avoid rupture and severe blood loss. Medicine Using methotrexate to end an ectopic pregnancy spares you from an incision and general anesthesia. Methotrexate is most likely to work: When your pregnancy hormone levels human chorionic gonadotropin, or hCG are low less than 5, When the embryo has no heart activity.
Surgery If you have an ectopic pregnancy that is causing severe symptoms, bleeding, or high hCG levels, surgery is usually needed.
Expectant management For an early ectopic pregnancy that appears to be naturally miscarrying aborting on its own, you may not need treatment.
If hCG levels do not drop or bleeding does not stop after taking methotrexate, your next step may be surgery. If you have surgery, you may take methotrexate afterward. What to think about Surgery versus medicine Methotrexate is usually the first treatment choice for ending an early ectopic pregnancy.
Regular follow-up blood tests are needed for days to weeks after the medicine is injected. There are different types of surgery for a tubal ectopic pregnancy.
As long as you have one healthy fallopian tube, salpingostomy a small tubal slit and salpingectomy part of a tube is removed have about the same effect on your future fertility. Although surgery is a faster treatment, it can cause scar tissue that could cause future pregnancy problems. Tubal surgery may damage the fallopian tube, depending on where and how big the embryo is and the type of surgery needed.
Prevention You cannot prevent ectopic pregnancy, but you can prevent serious complications with early diagnosis and treatment. Home Treatment If you are at risk for having an ectopic pregnancy and you think you may be pregnant, use a home pregnancy test.
Concerns about future pregnancy If you have had an ectopic pregnancy, you may worry about your chances of having a healthy or ectopic pregnancy in the future.
Medications Medicine can only be used for early ectopic pregnancies that have not ruptured. Medicine is most likely to work when an early ectopic pregnancy is not causing bleeding and: Your pregnancy hormone hCG, or human chorionic gonadotropin level is low less than 5, The embryo has no heart activity. Medicine choices Methotrexate is used to stop the growth of an early ectopic pregnancy.
What to think about Methotrexate treatment is usually the first choice for ending an early ectopic pregnancy. Methotrexate versus surgery If your ectopic pregnancy is not too far advanced and has not ruptured, methotrexate may be a treatment option for you. Surgery choices An ectopic pregnancy can be removed from a fallopian tube by using salpingostomy or salpingectomy.
The ectopic growth is removed through a small, lengthwise cut in the fallopian tube linear salpingostomy. The cut is left to close by itself or is stitched closed. A fallopian tube segment is removed. The remaining healthy fallopian tube may be reconnected. Salpingectomy is needed when the fallopian tube is being stretched by the pregnancy and may rupture or when it has already ruptured or is very damaged. What to think about When an ectopic pregnancy is located in an unruptured fallopian tube, every attempt is made to remove the pregnancy without removing or damaging the tube.
Future fertility Your future fertility and your risk of having another ectopic pregnancy will be affected by your own risk factors.
Medical management of ectopic pregnancy. Obstetrics and Gynecology, 6 : — Cunningham FG, et al. Ectopic pregnancy. In Williams Obstetrics, 23rd ed. New York: McGraw-Hill. Fritz MA, Speroff L In Clinical Gynecologic Endocrinology and Infertility, 8th ed. Philadelphia: Lippincott Williams and Wilkins. Early pregnancy risks. In Victoria, you can have two types of abortion: surgical and medication. Both types are safe and reliable. You can have a medication abortion up to nine weeks of pregnancy.
You can have a surgical abortion from around six weeks of pregnancy onwards. Age affects the fertility of both men and women, and is the single biggest factor affecting a woman? Androgen deficiency in women and its treatment is controversial, and more research is needed.
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Summary Read the full fact sheet. On this page. Symptoms of ectopic pregnancy Risk factors for ectopic pregnancy Contraception and ectopic pregnancy Diagnosis of ectopic pregnancy Treatment for ectopic pregnancy Early screening for ectopic pregnancy is vital Risk reduction for ectopic pregnancy Where to get help Things to remember.
About Search. Enable Autosuggest. You have successfully created a MyAccess Profile for alertsuccessName. Previous Chapter. Next Chapter. Heaton H. Heaton, Heather A. Tintinalli J. Judith E. Tintinalli, et al. McGraw Hill; Accessed November 12, Ectopic pregnancy and emergencies in the first 20 weeks of pregnancy. McGraw Hill.
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