Compare conditions

Put any two — or three — conditions side by side, adult or pediatric, to spot the look-alike differences fast, row by row.

Ectopic Pregnancy

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In one line

·A fertilized egg plants itself and starts growing outside the uterus, usually in the narrow fallopian tube.

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Normal physiology

·Normally, after fertilization happens in the fallopian tube, tiny hair-like sweepers called cilia push the fertilized egg down the tube and into the uterus over about five days, where it burrows into the thick, blood-rich lining and grows safely for nine months.

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What goes wrong

·Something damages or slows the cilia in the fallopian tube—usually old infection, surgery scars, or endometriosis—so the fertilized egg cannot finish the trip to the uterus and instead plants itself in the narrow tube, where it has no room to grow safely.

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Hallmark signs

·Missed period with a positive pregnancy test
·Sharp or cramping pain on one side of the belly or pelvis
·Vaginal bleeding or spotting (often lighter or darker than a normal period)
·Shoulder or neck pain that seems unrelated
·Dizziness, fainting, or feeling like you might pass out
·Severe, sudden belly pain that gets worse quickly
·An empty uterus on ultrasound even though the pregnancy test is positive
·Pregnancy hormone (hCG) level rises more slowly than expected

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Red flags · escalate now

·Sudden severe belly pain with dizziness or fainting (suggests rupture and internal bleeding)
·Shoulder or neck pain along with belly pain and a positive pregnancy test (blood irritating the diaphragm)
·Low blood pressure, fast heart rate, or pale/clammy skin (signs of shock from blood loss)
·Severe pain that keeps getting worse despite rest (the ectopic site may be tearing)
·Positive pregnancy test but no visible pregnancy in the uterus on ultrasound and hCG above the level where you should see something (discriminatory zone ~1500–2000 mIU/mL)

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Workup

·Serum quantitative beta-hCG (pregnancy hormone blood test)
·Transvaginal ultrasound
·Serum progesterone
·Complete blood count (CBC)
·Type and screen (blood type and antibody check)
·Culdocentesis (needle aspiration through the vaginal wall into the space behind the uterus)

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Treatment

·Emergency laparoscopy or laparotomy (surgery to open the belly) with salpingectomy (removing the whole tube) or salpingostomy (cutting open the tube and removing the embryo) if the patient is unstable (shock, dropping blood pressure) or the tube has ruptured
·Methotrexate — either single-dose intramuscular (50 mg/m² body surface area) or multi-dose protocol (1 mg/kg on days 1, 3, 5, 7) — if the patient is stable, beta-hCG is below 5,000 mIU/mL, the ectopic mass is smaller than 3.5 cm, there is no fetal heartbeat, and no signs of rupture
·IV fluid resuscitation (normal saline or lactated Ringer's bolus 500–1,000 mL wide open) and packed red blood cell transfusion if systolic BP is below 90 mmHg, heart rate is above 110 bpm, or hemoglobin drops below 7 g/dL
·RhoGAM (anti-D immune globulin) 50–120 mcg intramuscular within 72 hours if the patient is Rh-negative
·Serial beta-hCG monitoring every 48–72 hours after methotrexate (expect at least a 15% drop between days 4 and 7) and weekly ultrasound to confirm the mass is shrinking and no rupture has happened
·Patient education on rupture warning signs: sudden severe belly pain, shoulder pain, heavy vaginal bleeding, dizziness, fainting, nausea, or feeling like passing out. Instruct patient to go to the emergency department immediately if any of these happen.
·Expectant management (watch and wait without medication or surgery) if beta-hCG is very low (usually below 200 mIU/mL), dropping on its own, and the patient is stable with no pain or bleeding

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NCLEX trap

·A positive pregnancy test only tells you a pregnancy exists. It does NOT tell you WHERE the baby is growing. Always do an ultrasound to confirm the baby is inside the uterus, not stuck in the tube. Ectopic pregnancy has a positive test but an empty uterus on ultrasound.
·Vaginal bleeding with a positive test and an empty uterus on ultrasound is ectopic pregnancy until proven otherwise. Miscarriage happens when the baby was inside the uterus and then stopped growing. Ectopic pregnancy is when the baby never made it to the uterus — it got stuck in the tube or somewhere else.
·Shoulder pain plus positive pregnancy test plus empty uterus plus vaginal bleeding means ectopic pregnancy rupture until you prove otherwise. Blood pooling under the diaphragm (the breathing muscle) irritates the nerve that runs to the shoulder, so the shoulder hurts even though the problem is in the belly. This is a surgical emergency — the patient is bleeding inside.
·Always think ectopic pregnancy FIRST when you see positive pregnancy test plus empty uterus plus pelvic pain. A tender cervix can look like PID, but the ultrasound and pregnancy test tell the real story. Ectopic pregnancy needs surgery or methotrexate (a medicine that stops the pregnancy cells from growing), not antibiotics alone. Antibiotics will not fix ectopic pregnancy.
·Ectopic pregnancy will NOT go away safely on its own. The tube will rupture eventually — it is just a matter of time. Even stable patients need treatment: either methotrexate (if caught very early, the pregnancy is small, and the patient can come back for blood tests) or surgery. Waiting for ectopic pregnancy to rupture is waiting for the patient to bleed to death inside her belly.
·If the hCG (the pregnancy hormone) is above 1500 and you cannot see a baby in the uterus on a good transvaginal ultrasound, that is ectopic pregnancy until proven otherwise. By this hCG level, the baby should be visible as a tiny sac inside the uterus. An empty uterus at this level means the baby is stuck in the tube or somewhere else — this is ectopic pregnancy, and you cannot wait a week.

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