Table I-2-2. Risk Factors for Ectopic PregnancyIdiopathic No risk factorsClinical Findings.
Diagnosis. The diagnosis of an unruptured ectopic pregnancy rests on the results
of a quantitative serum β-hCG titer combined with the results of a vaginal
sonogram. It is based on the assumption that when a normal intrauterine
pregnancy has progressed to where it can be seen on vaginal sonogram at 5
weeks’ gestation, the serum β-hCG titer will exceed 1,500 mIU. With the lower
resolution of abdominal sonography, an IUP will not consistently be seen until 6
weeks’ gestation. The β-hCG discriminatory threshold for an abdominal
ultrasound to detect an intrauterine gestation is 6,500 mIU compared with 1,500
mIU for vaginal ultrasound.
Symptoms. The classic triad with an unruptured ectopic pregnancy is
amenorrhea, vaginal bleeding, and unilateral pelvic-abdominal pain. With a
ruptured ectopic pregnancy, the symptoms will vary with the extent of
intraperitoneal bleeding and irritation. Pain usually occurs after 6–8 menstrual
weeks.
Signs. The classic findings with an unruptured ectopic pregnancy are
unilateral adnexal and cervical motion tenderness. Uterine enlargement and
fever are usually absent. With a ruptured ectopic pregnancy, the findings
reflect peritoneal irritation and the degree of hypovolemia. Hypotension and
tachycardia indicate significant blood loss. This results in abdominal guarding
and rigidity.
Investigative findings. A β-hCG test will be positive. Sonography may or
may not reveal an adnexal mass, but most significantly no intrauterine
pregnancy (IUP) will be seen.