Ectopic pregnancy history and symptoms
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Symptoms
The most common presenting symptoms are amenorrhea and abdominal pain.
- The pain is usually in the lower abdomen, but can be generalized or radiate to the shoulder (especially in ruptured ectopics) and is present in 90% of patients.
- Vaginal bleeding is also common (50 – 80%), and can be difficult to distinguish from spontaneous abortion.
Early symptoms are either absent or subtle. Clinical presentation of ectopic pregnancy occurs at a mean of 7.2 weeks after the last normal menstrual period, with a range of 5 to 8 weeks. Later presentations are more common in communities deprived of modern diagnostic ability.
The early signs are:
- Pain and discomfort, usually mild. A corpus luteum on the ovary in a normal pregnancy may give very similar symptoms.
- Vaginal bleeding, usually mild. An ectopic pregnancy is usually a failing pregnancy and falling levels of progesterone from the corpus luteum on the ovary cause withdrawal bleeding. This can be indistinguishable from an early miscarriage or the 'implantation bleed' of a normal early pregnancy.
- Pain while having a bowel movement.
Patients with a late ectopic pregnancy typically have pain and bleeding. This bleeding will be both vaginal and internal and has two discrete pathophysiologic mechanisms.
- External bleeding is due to the falling progesterone levels.
- Internal bleeding is due to hemorrhage from the affected tube.
The differential diagnosis at this point is between miscarriage, ectopic pregnancy, and early normal pregnancy. The presence of a positive pregnancy test virtually rules out pelvic infection as it is rare indeed to find pregnancy with an active pelvic inflammatory disease (PID). The most common misdiagnosis assigned to early ectopic pregnancy is PID.
More severe internal bleeding may cause:
- Lower back, abdominal, or pelvic pain.
- Shoulder pain. This is caused by free blood tracking up the abdominal cavity, and is an ominous sign.
- There may be cramping or even tenderness on one side of the pelvis.
- The pain is of recent onset, meaning it must be differentiated from cyclical pelvic pain, and is often getting worse.
- Ectopic pregnancy is noted that it can mimic symptoms of other diseases such as appendicitis, other gastrointestinal disorders, problems of the urinary system, as well as pelvic inflammatory disease and other gynecologic problems.