Clinical signs - Symptoms
No specific symptom is an ectopic pregnancy. The presence of these symptoms does not necessarily mean the presence of an ectopic pregnancy. The existence of risk factors for ectopic pregnancy increases the likelihood of ectopic pregnancy. Some signs can sometimes miss the overall clinical picture. Each sign has a value more or less convincing:
* Delayed rules
* Metrorrhagia (genital bleeding), scanty, color, sepia (brown)
* Sided pelvic pain (lower abdomen), of varying intensity, radiating to the shoulder of gradual or sudden onset, stabbing
* In the absence of treatment: out of the fallopian tube with signs of internal bleeding and shock
* Malaise
* Form pseudo-abortion, which can simulate a spontaneous miscarriage, with the expulsion of debris related to endometrial decidualization (the "obsolete", thickening of the endometrium under the effect of a progesterone, secreted by the corpus luteum)
* No delay rules, but rules are in appearance or unusual abundance.
Evolution
Different evolutions of ectopic pregnancy are possible:
* Evolution gradual or abrupt, with the rupture of the organ bearing the pregnancy (usually a fallopian tube, but also a uterine horn, ovary, cervix etc. ...). This breakdown is responsible for internal bleeding with the installation of a shock can be fatal if untreated.
* Abortion tubo-peritoneal pregnancy can be aborted in the peritoneal cavity (abdominal cavity). Here, it can be absorbed either gradually or progressively form cysts (encysted haematocele "), is grafted onto a body neighborhood and continue its development (ovary, small intestine, colon, peritoneum, etc. ...).
Diagnosis
The clinical signs of an ectopic pregnancy are often misleading. For this reason, at any clinical doubt, a pregnancy test and pelvic ultrasound are recommended. The ultrasound findings are often indirect signs, also misleading. A misdiagnosis can have serious consequences.
The diagnosis is often not focused from the first consultation, but after repeated blood tests and ultrasounds to several days apart. Repeated blood tests quantitative serum β-HCG (Beta HCG) allows a kinetic curve. Repeat pelvic ultrasound allows to diagnose and assess the presence of signs of gravity of an ectopic pregnancy.
Clinical examination
Clinical examination can be very variable. Different signs can be more or less present, more or less intense:
* Pain in the pelvic palpation, lateralized to the right or left
* Pain in vaginal lateralized. Painful uterine mobilization. Palpation of a small latero-uterine mass on vaginal examination painful.
Investigations
plasma β-HCG
The determination of plasma β-HCG is a blood test. If there is a strong suspicion of ectopic pregnancy or if there are signs of seriousness, it must be done urgently. The results are obtained in less than an hour. Some biological rules can guide the physician to the diagnosis (kinetic curve of plasma β-HCG):