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Ectopic pregnancy

Extracted from Survival Guide to Midwifery, 2nd Edition (2012) Diane M. Fraser and Margaret A. Cooper, Oxford; Churchill Livingstone: 2012. Courtesy Elsevier

An ectopic pregnancy is one where implantation occurs at a site other than the uterine cavity. Sites can include:

  • A fallopian (uterine) tube
  • An ovary
  • The cervix
  • The abdomen.

Women require prompt, appropriate treatment for this life-threatening condition. Midwives need to consider the possibility of ectopic pregnancy being responsible for unexplained abdominal pain and bleeding in early pregnancy.

Risk factors for ectopic pregnancy

Any of the alterations of the normal function of the uterine tube in transporting the gametes contributes to the risk of ectopic pregnancy.

  • Previous ectopic pregnancy
  • Pelvic or tubal surgery
  • Emergency contraception in current pregnancy
  • Congenital abnormalities of the tube
  • Previous infection including chlamydia, gonorrhoea and pelvic inflammatory disease
  • Conception with intrauterine contraceptive device in situ
  • Assisted reproductive techniques
  • Smoking


Clinical presentation

Typical signs

  • Localised/abdominal pain
  • Amenorrhoea
  • Vaginal bleeding or spotting

Atypical signs

  • Shoulder pain
  • Abdominal distension
  • Nausea, vomiting
  • Dizziness, fainting

Tubal pregnancy rarely remains asymptomatic beyond 8 weeks.

  • Pelvic pain can be severe.
  • Acute symptoms are the result of tubal rupture and relate to the degree of haemorrhage there has been.
  • Ultrasound enables an accurate diagnosis of tubal pregnancy, making management more proactive.
  • Vaginal ultrasound, combined with the use of sensitive blood and urine tests which detect the presence of human chorionic gonadotrophin (HCG), helps to ensure diagnosis is made earlier.
  • If the tube ruptures, shock may ensue; therefore resuscitation, followed by laparotomy, is needed.
  • The mother should be offered follow-up support and information regarding subsequent pregnancies.

Further reading

The Ectopic Pregnancy Trust. Clinical features of an ectopic pregnancy.

NICE. Ectopic pregnancy and miscarriage: diagnosis and initial management. Clinical guideline 154.


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