Symptoms of ectopic preganancy

As about 98% of ectopic pregnancy presented as tubal pregnancy, and only 2% presented with other ectopic pregnancy variants ,  so the symptoms of ectopic pregnancy can be divided into tubal pregnancy symptoms and non tubal pregnancy symptoms , although that classification , the difference between these categories are minimal.

Tubal pregnancy symptoms

The clinical pictures of tubal pregnancy are very variable, there are disturbed cases which called rupture tubal pregnancy or ruptures ectopic pregnancy  , also there are undisturbed cases which called unruptured tubal pregnancy.

Ruptured ectopic pregnancy or rupture tubal pregnancy

The patient presented with short period of amenorrhea ,which may be absent , as the ectopic pregnancy may be disturbed around the time of menstruation and bleeding occur , and mistaken as true period , beside that amenorrhea, the patient presented with stabbing pain which denote that the ectopic has been ruptured , also there may be shoulder pain that denote diffuse intraperitoneal hemorrhage, which is a severe urgent case , after the pain the vaginal bleeding presented which may be slight at first due to shedding of decidua , and then may be severe results in hypovolemia , and the patient finally faint .

General examination reveled that  , the patient may be shocked and enter the intensive care unit immediately for correction of that shock or she may presented with  pallor , rapid pulse , low blood pressure , temperature is slightly low or may be normal , there may be signs of pregnancy like breast signs .

Abdominal examination revealed that lower abdominal tenderness , uterus may be enlarged corresponding to the period of amenorrhea , adenxal mass may be palpable in about 20% of cases .

Vaginal examination  also show bluish vagina and soft cervix as it is signs of pregnancy , also show tender posterior fornix , severe unilateral lower abdominal pain when the cervix is moved .

If that patient do pregnancy test it will be positive , and in that case she must examined with ultrasound , to prove ectopic pregnancy and differentiate it from other bleeding in early pregnancy.

Undisturbed tubal pregnancy

patient presented short period of amenorrhea , with lower abdominal pain , and no bleeding , with positive pregnancy test , in that type the patient must be examined with ultrasonography for identifying is that ectopic pregnancy or other cause of abdominal pain during pregnancy.

Non tubal ectopic pregnancy symptoms

Ovarian pregnancy

The clinical picture is similar to tubal pregnancy , with he symptoms of ruptured ectopic pregnancy are early , there are operative criteria show difference between them , as the tube in affected side is intact , the ectopic occupies the ovary , the ectopic pregnancy connected to the uterus by ovarian ligament , finally the ovarian tissue surround sac .

Abdominal pregnancy

Abdominal pregnancy mean that the pregnancy sac may be implanted first  in peritoneal cavity  or tubal pregnancy occurs first and then it move to be implanted in abdominal cavity , in that type of pregnancy ultrasongraphy help in it’s diagnosis , and once diagnosed it must urgently treated .

cervical pregnancy

It is very rare type of ectopic pregnancy , it presented with painless bleeding soon after implantation , the cervix become destined , thin walls with partially dilated external Os , mexthotreate is the primary option for it’s treatment , as surgery removal results in severe bleeding .

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