Ectopic Pregnancy

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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:

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

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

Primary Survey
Support and reassurance
Perform vital sign survey
Consider oxygen
Secondary / CNS Survey (as required)
Liaise with obstetrics unit in the metropolitan area or local hospital in country areas, recording all advice in EPCR
Consider CSPSOC for advice

Intermediate Care (EMT / Level 2)

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)

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

Key Terms & Links

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