acute
Last reviewed 09/2023
About 15-20% of ectopic pregnancies present acutely, commonly when the ovum implants into the narrow part of the Fallopian tube. The lumen of the isthmus is rarely larger than 1 mm in diameter and the trophoblast may easily erode through the tubal wall.
A ruptured ectopic pregnancy is usually dramatic and often not forgotten. Features include:
- severe pain in the pelvis and lower abdomen, and often in in the shoulder tips due to diaphragmatic irritation from blood in the peritoneum
- tenesmus may be a feature
- collapse and eventual hypovolaemic shock
- minimal vaginal loss, usually slight dark red
- vaginal examination is extremely painful especially on moving the cervix. It may provoke further bleeding and should be kept to a minimum