# Ectopic pregnancy - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - 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 date: 2026-08 ## Verified against - No dose - referral pathway, no medicine given in primary care ## Treatment metadata - No drug therapy in primary care (Referral & Advice) ## Complete treatment card ```text ECTOPIC PREGNANCY 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 Review status: REVIEWED against the source listed above (2026-08) 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 Source StatPearls "Ectopic Pregnancy" - disease-level clinical article Status traced to the source above 1. NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE) [1st line] Adult 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 Peds Adult-only condition - paediatric section not applicable 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. Caution 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. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)