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Introduction
  • Ectopic pregnancy is when a zygote implants outside the uterus – typically in the fallopian tube. As it grows, it can rupture, causing major internal haemorrhage. A suspected ruptured ectopic pregnancy is considered a medical emergency.
Clinical Presentation

The basic triad of symptoms include:

  • Abdominal pain (in 80-90% of women)
  • Vaginal bleeding (75%)
  • Amenorrhoea

Other symptoms may include:

  • Abdominal pain may radiate to the neck or shoulder 
  • Episodes of syncope or presyncope in early pregnancy 
  • Lower abdominal tenderness or palpable mass
  • Common non-specific symptoms include vomiting and diarrhoea, mimicking gastroenteritis
  • Tachycardia / pallor / hypotension / shock / syncope / orthostatic hypotension
Exclusion Criteria
Exclusion Criteria
Risk Assessment
  • Paramedics should consider a differential diagnosis of ectopic pregnancy in all women of reproductive age who present with abdominal pain, with a high suspicion when pain is accompanied by vaginal bleeding. 
  • Clinical manifestations generally occur 6-8 weeks after last normal menstrual period
Management
Primary Care
Intermediate Care (EMT / Level 2)
  • As per Primary Care guidelines
Advanced Care (AP)
  • Apply cardiac monitor
  • IV access - consider large bore cannula
  • Fluid therapy as per medication protocol with emphasis on permissive hypotension
  • Consider analgesia
Critical & Extended Care (CCP, PSO)
  • As per Advanced Care (AP) guidelines
Additional Information
  • If there is a high index of suspicion for ruptured ectopic pregnancy, officers should consider priority transport to the nearest ED, preferrably with an obstetrics unit if patient condition allows. 

References
References
Key Terms & Links
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