Intended for healthcare professionals

Practice Easily Missed?

Ectopic pregnancy

BMJ 2010; 341 doi: (Published 30 July 2010) Cite this as: BMJ 2010;341:c3770

This article has a correction. Please see:

  1. Sheikha Al-Jabri, fellow of minimally invasive gynaecology,
  2. Michael Malus, associate professor, department of family medicine,
  3. Togas Tulandi, professor of obstetrics and gynaecology and Milton Leong chair in reproductive medicine
  1. 1McGill University, Montreal, QC, Canada H3A 1A1
  1. Correspondence to: S Al-Jabri s_umreem{at}
  • Accepted 20 May 2010

Case scenario

A 33 year-old woman presented to the emergency department with a five day history of low abdominal pain. Her last menstrual period was five weeks before; she said she was using progesterone-only pills for contraception and had a history of Chlamydia infection, so a pregnancy test was not done. She was diagnosed with pelvic inflammatory disease and prescribed antibiotics. She returned to the emergency department two days later with worsening abdominal pain, hypotension, and tachycardia. An urgent pregnancy test and ultrasonography led to the diagnosis of a tubal ectopic pregnancy.

In women of reproductive age, ruling out ectopic pregnancy is mandatory as it is still the leading cause of death in the first trimester of pregnancy. This needs a high index of suspicion and an early pregnancy test. A negative test result excludes ectopic pregnancy, and a positive result demands further clinical, biochemical, and ultrasound examination to exclude or confirm ectopic pregnancy. The possibility of medical treatment for ectopic pregnancy makes early diagnosis even more important.

How common is it?

The estimated incidence of ectopic pregnancy in the United Kingdom is 11.1 per 1000 reported pregnancies.1 However, some of these cases could be misdiagnosed. A retrospective study estimated that 12% of ectopic pregnancies were missed at initial presentation.2 In a prospective consecutive case series among women with ectopic pregnancy who …

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