Clinical Features

• Patients usually present with signs and symptoms 4–6 weeks after their last menstrual period.

• Lower abdominal pain and guarding (ectopic pregnancy is often mistaken for appendicitis due to the similarity of symptoms)

• Possibly, vaginal bleeding

• Signs of pregnancy

  • Amenorrhea

  • Nausea

  • Breast tenderness

  • Frequent urination

• Tenderness in the area of the ectopic pregnancy

• Cervical motion tenderness, closed cervix

• Enlarged uterus

• Interstitial pregnancies tend to present late, at 7–12 weeks of gestation, because of myometrial distensibility.

Right lower quadrant pain may indicate appendicitis. Cervical motion tenderness may be a sign of PID.

• Acute course with sudden and severe lower abdominal pain (acute abdomen)

• Signs of hemorrhagic shock (e.g., tachycardia, hypotension, syncope)

  • In some cases acute hemorrhage may lead to bradycardia.

  • The exact mechanism behind this phenomenon is not yet fully understood.

    • One theory is the activation of mechanoreceptors in the left ventricle that trigger a vagally mediated reflex.

    • Another suggested cause for bradycardia is a vagally mediated parasympathetic reflex that gets activated by the blood in the peritoneum.

• More common in interstitial pregnancy