Rapid Review: Ectopic Pregnancy

Reviewed January 2024

Ectopic Pregnancy

• Risk factors: prior ectopic, PID, tubal surgery, IVF, IUD in situ
• Sx: abdominal pain, pelvic pain, amenorrhea, or vaginal bleeding
• Labs: positive pregnancy test, serum beta-hCG levels may be lower than expected
• Diagnosis: pelvic ultrasound
  • Definitive dx: gestational sac with a yolk sac or embryo outside of the uterine cavity
    • Free fluid with debris is suggestive of ruptured ectopic
• Most commonly located in a fallopian tube
• Treatment is methotrexate or surgery

Sample question:

A 24-year-old woman presents to the emergency department with abdominal pain. She states that the pain started acutely this morning and has been progressively worsening, causing her to vomit. The patient has a medical history of several sexually transmitted infections. She is currently sexually active with both men and women. Her last menses was 3 months ago. Physical exam is notable for tenderness in the right lower quadrant of the abdomen, blood in the vagina, and a tender adnexal mass on pelvic exam. Which of the following is the most likely diagnosis?