Ectopic pregnancy is one of the commonest reasons for maternal morbidity and mortality in early pregnancy.
The reason why ectopic pregnancy can be potentially fatal is because of lack of recognition of symptoms and signs, both on the part of the sufferer and the health professionals with whom the woman makes initial contact.
This fact has been highlighted in the last 3 confidential enquiries into maternal deaths in the UK.
Ectopic pregnancy often “masquerades” with symptoms common to other illnesses, or symptoms common to a very bad menstrual period.
Ectopic pregnancy can present as an acute event, this happens in about 10% of women (this is where the tube has ruptured and is bleeding). In between 60-80% of women it is diagnosed on the basis of symptoms and signs in combination with risk factors, and in a minority of women it is picked up on routine ultrasound scan in early pregnancy.
It is important that women and their carers are educated about the dangers of ectopic pregnancy.
1. Missed Period: to have a pregnancy outside the womb a woman has to be pregnant and to be pregnant theoretically a menstrual period will need to be missed. As we all know some women do not notice they have missed periods particularly those with long cycles or those with irregular cycles.
2. Abdominal pain: abdominal pain is the commonest symptom of ectopic
Pregnancy. However women suffer from abdominal pain for many reasons other than pregnancy.
IT IS IMPORTANT THAT IN ANY WOMAN OF CHILDBEARING AGE WHO PRESENTS WITH ABDOMINAL PAIN ECTOPIC PREGNANCY NEEDS TO BE EXCLUDED, before considering other causes.
3. Vaginal bleeding: this is a common symptom and sign of ectopic pregnancy. The bleeding is usually dark brown and persistent. Some women may mistake it as just a “not so normal” period. This sort of bleeding with or without abdominal pain needs to be investigated.
For women in whom the pregnancy and tube have ruptured there is internal bleeding and this is associated with a number of other symptoms due to the irritation the blood causes within the abdomen
4. Vomiting
5. Shoulder tip pain
6. Pain on movement this may be at the time of vomiting or coughing
7. Fainting spells and syncope
8. Diarrohea
Unfortunately when women present with these so-called atypical symptoms the diagnosis of ectopic pregnancy is most likely to be missed
A recent French study looked at designing a questionnaire to enable clinicians make an accurate diagnosis on the basis of symptoms
Symptoms associated with the diagnosis of rupture of ectopic pregnancy included
· Vomiting during the bout of abdominal pain
· Diffuse abdominal pain
· Acute pain lasting for more than 30 minutes
· Flashing pain
The sensitivity of ectopic pregnancy diagnosis in the presence of one or more of these features is about 93%
The reason why ectopic pregnancy can be potentially fatal is because of lack of recognition of symptoms and signs, both on the part of the sufferer and the health professionals with whom the woman makes initial contact.
This fact has been highlighted in the last 3 confidential enquiries into maternal deaths in the UK.
Ectopic pregnancy often “masquerades” with symptoms common to other illnesses, or symptoms common to a very bad menstrual period.
Ectopic pregnancy can present as an acute event, this happens in about 10% of women (this is where the tube has ruptured and is bleeding). In between 60-80% of women it is diagnosed on the basis of symptoms and signs in combination with risk factors, and in a minority of women it is picked up on routine ultrasound scan in early pregnancy.
It is important that women and their carers are educated about the dangers of ectopic pregnancy.
1. Missed Period: to have a pregnancy outside the womb a woman has to be pregnant and to be pregnant theoretically a menstrual period will need to be missed. As we all know some women do not notice they have missed periods particularly those with long cycles or those with irregular cycles.
2. Abdominal pain: abdominal pain is the commonest symptom of ectopic
Pregnancy. However women suffer from abdominal pain for many reasons other than pregnancy.
IT IS IMPORTANT THAT IN ANY WOMAN OF CHILDBEARING AGE WHO PRESENTS WITH ABDOMINAL PAIN ECTOPIC PREGNANCY NEEDS TO BE EXCLUDED, before considering other causes.
3. Vaginal bleeding: this is a common symptom and sign of ectopic pregnancy. The bleeding is usually dark brown and persistent. Some women may mistake it as just a “not so normal” period. This sort of bleeding with or without abdominal pain needs to be investigated.
For women in whom the pregnancy and tube have ruptured there is internal bleeding and this is associated with a number of other symptoms due to the irritation the blood causes within the abdomen
4. Vomiting
5. Shoulder tip pain
6. Pain on movement this may be at the time of vomiting or coughing
7. Fainting spells and syncope
8. Diarrohea
Unfortunately when women present with these so-called atypical symptoms the diagnosis of ectopic pregnancy is most likely to be missed
A recent French study looked at designing a questionnaire to enable clinicians make an accurate diagnosis on the basis of symptoms
Symptoms associated with the diagnosis of rupture of ectopic pregnancy included
· Vomiting during the bout of abdominal pain
· Diffuse abdominal pain
· Acute pain lasting for more than 30 minutes
· Flashing pain
The sensitivity of ectopic pregnancy diagnosis in the presence of one or more of these features is about 93%
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