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Acute

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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About 15-20% of ectopic pregnancies present acutely, commonly when the ovum implants into the narrow part of the Fallopian tube. The lumen of the isthmus is rarely larger than 1 mm in diameter and the trophoblast may easily erode through the tubal wall.

A ruptured ectopic pregnancy is usually dramatic and often not forgotten. Features include:

  • severe pain in the pelvis and lower abdomen, and often in in the shoulder tips due to diaphragmatic irritation from blood in the peritoneum
  • tenesmus may be a feature
  • collapse and eventual hypovolaemic shock
  • minimal vaginal loss, usually slight dark red
  • vaginal examination is extremely painful especially on moving the cervix. It may provoke further bleeding and should be kept to a minimum

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