Ectopic pregnancy

1. Big picture

Ectopic pregnancy is one of the most important gynaecological emergencies. It means implantation of a fertilized ovum outside the normal uterine cavity, most commonly in the fallopian tube.

The examiner wants you to think:

Positive pregnancy test + pain/bleeding
        ↓
Assume ectopic pregnancy until proven otherwise
        ↓
Is the patient haemodynamically stable?
        ↓
If unstable → resuscitate and operate
If stable → confirm location with transvaginal ultrasound + serial beta-hCG
        ↓
Treat by expectant, medical, or surgical management

The life-threatening event is tubal rupture → intraperitoneal bleeding → hypovolaemic shock.

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