Ectopic Pregnancy and Spontaneous Abortion

Ectopic Pregnancy

Ectopic (usually tubal) pregnancy is a common obstetric problem (occurring in about 1 in 150 pregnancies) and is typically included in the differential diagnosis of pelvic pain in women of childbearing age. In addition to pain, ectopic pregnancy may produce abnormal uterine bleeding, adnexal tenderness, a unilateral adnexal mass, and decreased blood hemoglobin values (from internal hemorrhage). In advanced cases, patients may present with hypovolemic shock.

Ectopic pregnancies may implant anywhere in the abdominal cavity, but are most common in the fallopian tube (tubal pregnancy). Ectopic pregnancies usually become symptomatic within 4-6 weeks after conception. At that point, the normal hCG increase levels off. A decline in the rate of hCG increase (less than doubling every two days) combined with the symptoms mentioned above is highly suggestive of ectopic pregnancy. Culdocentesis (sampling fluid from the cul-de-sac between the uterus and rectum) often reveals blood.

Follow-up testing typically involves ultrasound to attempt to identify a gestational sac in the uterus. If the gestational sac is absent in the setting of elevated hCG, then ectopic pregnancy is essentially confirmed. Ultrasound may also be able to identify an adnexal mass directly.

Spontaneous Abortion

Spontaneous abortion is common in the first trimester, occuring in about 15% of pregnancies. Impending abortion typically shows a slowing in the rate of hCG increase, with a decline in hCG levels as abortion takes place.

Pregnancy Testing

Gestational Trophoblastic Disease

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Last modified: 1/20/97; Author: J. Harrison