What symptoms can a woman experience with ectopic pregnancy?

For women in whom it is suspected that they are in danger of ectopic pregnancy, with the use of testing and imaging it is now often possible to determine a diagnosis of ectopic pregnancy before symptoms develop. It is important to be aware of the symptoms of ectopic pregnancy because it can occur in any sexually active woman whether or not she is using contraceptives or has undergone tubal sterilization ("tying the tubes"). Symptoms occur as the embryo grows and as bleeding occurs from expelling of blood through the fimbrial opening of the Fallopian tube or from rupture of the tube. Mild bleeding can occur without causing symptoms. The most common symptoms that a woman presents to a doctor are abdominal pain (90-100% of women), absence of menses ("not getting your period") (75-90%) and unexpected bleeding through the vagina (50-80%). Before rupture occurs, there might be just a vague soreness or spastic (colic) pain in the abdomen. Abdominal pain can be generally everywhere, or it can be in a specific spot (localized) in one side or both sides. About one quarter of women also have pain in the shoulder because of diaphragmatic (broad muscle under the lungs and heart that separates the chest from the abdomen and helps move the lungs during normal breathing) irritation from blood in the abdomen. During rupture, the pain usually becomes intense. Other symptoms also occur less commonly. Dizziness and fainting occur in about one third of women with symptoms. Pregnancy symptoms also occur in about 20% of women with symptoms. 10% of the time, there can be an urge to have bowel movement (defecate).

Summary: It is important to be aware of the symptoms because an ectopic pregnancy can occur whether or not a woman is on oral contraceptives or has undergone tubal sterilization. The most common symptoms are (1) abdominal pain (usually caused by blood), (2) absence of expected menses and (3) unexpected bleeding through the vagina. Other less common symptoms include (1) referred shoulder pain, (2) dizziness and fainting, (3) pregnancy symptoms and (4) defecation urgency.

What findings can a doctor find upon physical examination of a woman with an ectopic pregnancy?

The most common finding is tenderness in the abdomen and pelvis. Half the time, a mass is felt on the sides of the uterus (adnexal mass). In about one third of women, an enlarged uterus is found which is smaller than would be found in a normal pregnancy, except when an interstitial pregnancy is present. Accelerated heart rate (tachycardia) and low blood pressure (hypotension) can be found if there has been profuse blood loss. However, in most early ectopic pregnancies no abnormal findings can be found.

Summary: Most common sign is abdominal and pelvic pain. Adnexal mass (50%) Smaller enlargement of uterus than would be expected in a normal pregnancy (33%). Tachycardia and hypotension can be found with profuse blood loss. However, in most early ectopic pregnancies, no abnormal findings can be found.

What other disorders can be confused with ectopic pregnancy?

Before rupture the symptoms and physical examination findings are non-specific and can occur with other gynecological disorders, such as salpingitis, impending or incomplete abortion, ruptured corpus luteum, appendicitis, dysfunctional uterine bleeding, adnexal torsion, degenerative uterine leiomyoma ("fibroids") and endometriosis.

Summary: Differential diagnosis (especially unruptured ectopic pregnancy) includes numerous other gynecological disorders (see above).