Acute

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