Dawaa Reference

chronic

Ectopic pregnancy

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources3 sources

Ectopic Pregnancy - StatPearls (NCBI Bookshelf NBK539860) - https://www.ncbi.nlm.nih.gov/books/NBK539860/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class WD69 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care

Verified against1 document
  • No dose - referral pathway, no medicine given in primary care

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (12)

  • Ectopic pregnancy often starts as colicky abdominal or pelvic pain localized to one side [abdominal pain · pelvic pain]
  • Shoulder pain, urinary symptoms, and rectal pressure can occur, along with dizziness, fainting, nausea, and vomiting [dizziness · joint pain · nausea · shoulder pain · syncope · vomiting]
  • A missed period or abnormal uterine bleeding raises suspicion of pregnancy, including a possible ectopic [abnormal uterine bleeding]
  • A cesarean scar ectopic pregnancy can range from silent, found on routine ultrasound, to presenting as uterine rupture [scarring]
  • The usual picture is lower abdominal pain, typically on one side, together with vaginal bleeding [abdominal pain · lower abdominal pain · vaginal bleeding]
  • Shoulder pain, fainting, dizziness, or pain in the pelvis that is severe, are the features that mean it may already have ruptured [abdominal pain · dizziness · joint pain · pelvic pain · shoulder pain · syncope]
  • It complicates about 1% to 2% of pregnancies
  • It causes 2.7% of all pregnancy-related deaths, so it is a condition that kills
  • The tubal damage behind it comes from previous gonorrhoea or chlamydia, tubal surgery including sterilisation, a previous ectopic, or diethylstilbestrol exposure before birth
  • Conceiving with an intrauterine device in place, or while on a progesterone-only contraceptive, is a further risk factor
  • Rarely it implants outside the tube altogether - in the cervix, an ovary, the abdomen, a uterine cornu, or a caesarean scar [scarring]
  • Those extratubal ones are less likely to carry any of the usual risk factors or any tubal disease, which makes both diagnosis and management harder

Signs — what you find (3)

  • Tachycardia and hypotension on exam signal hemodynamic instability [hypotension · tachycardia]
  • Abdominal guarding on palpation raises concern for free fluid from a ruptured ectopic pregnancy or peritonitis [guarding]
  • Bimanual exam may reveal an adnexal mass or tenderness [pelvic mass]

Tests (7)

  • A beta-hCG over 2000 mIU/mL with no intrauterine pregnancy seen on ultrasound strongly suggests an ectopic pregnancy
  • A viable intrauterine pregnancy with an initial beta-hCG under 1500 mIU/mL typically rises at least 49% over 48 hours
  • A slower rise, or a fall of at least 21% over 48 hours, points toward miscarriage or ectopic pregnancy
  • ACOG suggests a discriminatory beta-hCG cutoff of up to 3500 mIU/mL before expecting to see an intrauterine pregnancy
  • Transvaginal ultrasound is the gold standard, confirmed when a yolk sac or embryo is seen outside the uterus
  • The double decidual sign of an early intrauterine pregnancy is typically visible by the fifth week
  • MRI can help in select cases, such as a large uterine fibroid obscuring the ultrasound view

If not this — what else fits (9)

  • Ovarian torsion
  • Tubo-ovarian abscess
  • Appendicitis
  • Hemorrhagic corpus luteum
  • Ovarian cyst rupture
  • Threatened miscarriage
  • Incomplete miscarriage
  • Pelvic inflammatory disease
  • Ureteral calculi

SourceStatPearls "Ectopic Pregnancy" - disease-level clinical article

Presentation findings are traced to the source above.

1

NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE)

1st line
Adult dose and duration

A life-threatening pregnancy complication; the GP must recognise the presentation (missed period, pain, bleeding) and refer immediately as an emergency. Methotrexate is a specialist-directed option in select stable cases and is not typically started in general practice. - Refer, with advice

Paediatric dose

Adult-only condition - paediatric section not applicable

Dose source

No dose - referral pathway, no medicine given in primary care

Why

A life-threatening pregnancy complication; the GP must recognise the presentation (missed period, pain, bleeding) and refer immediately as an emergency. Methotrexate is a specialist-directed option in select stable cases and is not typically started in general practice.

Cautions
  • Severe abdominal pain, shoulder-tip pain, dizziness, or collapse in a woman of reproductive age with a positive pregnancy test suggests a ruptured ectopic pregnancy - a surgical emergency.
  • No medicine is prescribed for this in primary care - this entry is for recognition and referral. Anything given is decided by the service it is referred to.

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.