Ectopic Pregnancy A Review and Update
Authors: Kodzo-Grey Venyo Anthony 
Published: July 2024

Ectopic pregnancy is a terminology which is utilized for the scenario in which a fertilized eggs has implanted outside the uterus [5] which usually has tended to be within one of the fallopian tubes. The classical manifestations of ectopic pregnancy do include abdominal pain and bleeding per vaginam; nevertheless, it has been stated that less than 50% of women who are afflicted by ectopic pregnancy are stated to have both symptoms of abdominal pain and vaginal bleeding. The lady who has ectopic pregnancy could describe the abdominal pain as sharp pain dull pain, or crampy pain. The abdominal pain could also extend to affect the ipsilateral shoulder due to irritation of the diaphragm in the scenario of of bleeding from the ectopic pregnancy into the abdomen. Severe bleeding into the abdomen from ectopic pregnancy site into the abdomen or through the vagina could emanate in the patient developing a fast heart rate (tachycardia, fainting, or shock and on rare occasions the foetus may not have the chance to survive [6] When the patient who has ectopic pregnancy manifests with abdominal pain and bleeding from the vagina, the patient tends to be seen by a gynaecologist but when the patient presents with abdominal pain, loin pain or shoulder tip pain, the patient could in the first instance be seen by a General Practitioner, a general surgeon, a physician or a Urologist on rare occasions and hence even though ectopic pregnancy is a gynaecological practitioner, every clinician including General Duty Practitioners and Emergency clinicians need to have a high index of suspicion for ectopic pregnancy in order to establish a quick and accurate diagnosis to enable prompt and appropriate treatment of the patient. Some of the risk factors for the development of ectopic pregnancy do include: pelvic inflammatory disease, smoking of tobacco, previous tubal surgery, a history of infertility, utilization of assisted reproductive technology. In most hospitals globally, diagnosis of ectopic pregnancy tends to be established via utilization of blood tests for human chorionic gonadotrophin and the undertaking of ultrasound scan of abdomen and pelvis to demonstrate presence of the ectopic pregnancy. Nevertheless, in some small hospitals where facilities for ultrasound scan are not immediately available as well as in scenarios where serum beta human chorionic gonadotrophin are not immediately available on such rare occasions based upon a high index of suspicion for ectopic pregnancy the emergency general duty practitioner tends to subject the patient to surgical operation and during the procedure the ectopic pregnancy would be diagnosed and dealt with accordingly. Some of the differential diagnoses of ectopic pregnancy include: miscarriage, torsion of the ovary, appendicitis if the ectopic pregnancy is on the right side, rupture of corpus luteum cyst. Some of the treatment options that have been utilized for ectopic pregnancy include: surgery with various forms of surgical operation including salpingectomy, as well as achieving abortion via treatment with methotrexate. With regard to mortality associated with ectopic pregnancy the mortality has tended to 0.2%, but the mortality associated with ectopic pregnancy within the developing world has been 2%. Ectopic pregnancy is stated to account for 1.5% of pregnancies within the developed world. Conclusion Ectopic pregnancy is a condition that tends to manifest with bleeding from the vagina plus abdominal pain but it could also manifest as abdominal pain alone and hence a patient with ectopic pregnancy may initially present to an emergency clinician, an obstetrician, / gynaecologists, a General Practitioner, a General Surgeon and on very rare occasions to a Urologist. A high index of suspicion is required to diagnose ectopic pregnancy based upon determination of serum Beta Human Chorionic Gonadotrophin levels as well as undertaking of ultrasound scan of abdomen and pelvis in order to provide appropriate and effective treatment based upon the clinical state of the patients as well as whether or not the patient has a desire to be pregnant again in the future. It is important to appreciate that a patient who has ectopic pregnancy could be seen for the first time by various clinicians including gynaecologists, emergency clinicians, general surgeons and even urologists. A lady who has pain in the right lower quadrant of the abdomen could be considered to have differential diagnoses, some of which include appendicitis, and ureteric colic and hence it is important to consider ectopic pregnancy as a possible diagnosis in cases of right sided lower abdominal and suprapubic pain Considering that occasionally a patient who has ectopic pregnancy may first be seen by non-gynaecologists, it is important for all clinicians to have a high index of suspicion to exclude ectopic pregnancy when they see ladies in their reproductive ages who manifest with vaginal bleeding and abdominal pain or abdominal pain alone.