Synopsis
Recognise typical and atypical ectopic pregnancy, identify concealed intraperitoneal bleeding and prioritise resuscitation and definitive haemorrhage control over diagnostic delay.
- Consider ectopic pregnancy in anyone with pregnancy potential and abdominal or pelvic pain, vaginal bleeding, amenorrhoea, syncope, gastrointestinal or urinary symptoms, even when pregnancy was not suspected.
- Common features are unilateral pelvic pain, missed period and vaginal bleeding; atypical presentations are common and the classic triad is neither sensitive nor required.
- Check a urine pregnancy test early in reproductive-age abdominal pain or collapse with consent and explain why it changes emergency care.
Key red flags
Collapse, confusion, clammy pallor, tachycardia, hypotension, oliguria or rising lactate indicates haemorrhagic shock and may appear after substantial concealed blood loss.
Investigation priorities
Rapidly identify pregnancy in abdominal pain, bleeding, collapse or atypical gastrointestinal and urinary presentations.
Management branches
Possible pregnancy coexists with shock, collapse, peritonism or strong concern about pain or bleeding.
- Call senior gynaecology, anaesthesia, theatre and transfusion support; perform ABCDE, gain two large-bore IV accesses, take urgent bloods and keep the patient warm.
- Start blood-component resuscitation and major-haemorrhage protocol when indicated, provide analgesia and avoid delaying definitive treatment for serial hCG or a formal scan.
Pain, bleeding or risk factors occur in a haemodynamically stable pregnant patient.