••• Chapter 29^ Ectopic Pregnancy^281
❍ How deep does the trophoblast invade into the tube?
As there is no decidua to limit trophoblast growth, the pregnancy frequently grows through the muscularis of
the tube.
❍ What percentage of women with ectopic pregnancy report “passing tissue”?
Five to ten percent of women with ectopic pregnancy report passing tissue; women with ectopic pregnancy can
pass the decidual cast, which can be misinterpreted as a spontaneous abortion.
❍ What are the most common symptoms of ectopic pregnancy?
Pain, absence of menses, and irregular vaginal bleeding.
❍ What are some of the symptoms associated with tubal rupture and hemoperitoneum?
Worsening pain, shoulder pain (due to diaphragmatic irritation), and dizziness/syncope.
❍ What is the most common location of pain with an ectopic pregnancy?
Most commonly the pain is generalized over the abdomen; when localized the most common site is unilateral
lower quadrant. Shoulder pain is also present in approximately one quarter of women with a ruptured ectopic
pregnancy.
❍ What sign can distinguish an ectopic pregnancy from PID?
Fever is rare with ectopic pregnancy (<2% of women).
❍ How often is an adnexal mass found in women with an ectopic pregnancy?
Fifty percent of women with an ectopic pregnancy have an adnexal mass.
❍ How often is an ectopic pregnancy diagnosed the first time the patient presents?
About half of patients are incorrectly diagnosed at least once prior to identification of the ectopic pregnancy.
❍ What are the most commonly used tools for establishing a diagnosis of ectopic pregnancy?
Serial human chorionic gonadotropin (hCG) levels and transvaginal ultrasound are the most common tools for
diagnosing ectopic pregnancy.
❍ What three patterns of hCG rise can be seen with an ectopic pregnancy?
The hCG patterns associated with an ectopic pregnancy can be an abnormal rise (see previous question), a falling
level, or a shift to the right (normal rise occurring later than expected based on menstrual dates).
❍ How is the hCG level used to diagnose ectopic pregnancy?
Approximately 85% of women with ectopic pregnancy have serum hCG levels lower than those seen in women
with intrauterine pregnancies at a similar gestational age. However, hCG levels alone cannot differentiate a normal
pregnancy from an ectopic or spontaneous abortion. hCG levels should be monitored over at least a 48-hour
period, and if the rate of rise or fall of the hCG is outside the established range, an ectopic pregnancy should be
suspected. If the initial hCG level is low, a third level should be obtained to confirm the trend.