Pregnancy outside the uterus, usually in the uterine tubes; could result in an emergency when the tube ruptures
Cause
- Partial blockage of the tube due to a previous infection
- Congenital malformation of the fallopian tubes
- Excessively long tubes
Risk factors
- History of prior ectopic pregnancy
- Prior abdominal or tubal surgery
- History of PID, endometriosis, history of infertility
- Cigarette smoking
- Multiple sexual partners
Clinical features
- There may be a period of amenorrhoea as in normal pregnancy
- Lower abdominal pain, often acute and followed by slight bleeding from the vagina
- If the tube ruptures, the patient may suddenly become anaemic and go into shock
- Abdomen may be very tender with rebound tenderness and guarding on palpation
- Abdomen may not be moving with normal breathing
- Tenderness of moving cervix during vaginal examination
- There may be features of free fluid in the abdomen
Differential diagnosis
- Other causes of acute abdominal pain and vaginal bleeding, e.g. twisted ovarian cyst
- Appendicitis, pelvic inflammatory disease
- Incomplete abortion
Investigations
- Usually diagnosed clinically
- If the tube ruptures, there may be little time for investigations but ultrasound could be useful (if the
patient is not in shock)
- If the tube ruptures, there may be little time for investigations but ultrasound could be useful (if the
- Pregnancy test (to exclude other causes)
- Complete blood count, blood grouping and cross-matching
MANAGEMENT
- Set up IV drip with normal saline and run very slowly just to maintain IV access
- Refer to hospital for surgery
Note
- DO NOT RUN A LOT OF FLUIDS BEFORE SURGERY, as this raises blood pressure, which may worsen the
patient’s bleeding, and worsen state of shock.