How To Differentiate Clinically between Abortion & Ectopic Pregnancy
* The main presentation of abortion is bleeding & the main presentation of ectopic is pain.
* Pain & tenderness in ectopic is more in one iliac fossa & in abortion is suprapubic (very important sign).
* Vaginal bleeding is fresh bright red in case of abortion & dark brown in case of ectopic dt.the long journey of blood from tube through uterus till cx & vagina, that makes it hemolysed.
* By P/V; if you moved cx to any side (Rt./Lt.) there will be severe pain in case of ectopic pregnancy & not in abortion.
Live Clinical Scenario of Unruptured Ectopic pregnancy :
How to suspected ectopic from history & examination?
A case of primary infertility for 3 years dt. severe PID who received induction of ovulation outside & now PG after +ve pregnancy test, 6-8 wk, come to maternity ER/clinic C/O severe lower abdominal pain with mild brownish spotting; then by examination there is severe tenderness in one iliac fossa more than suprapubic& P/V minimal bleeding with cervical motion tenderness to one side. Vital signs; BP normal, pulse high normal dt.pain.
Take the pt. from her hand to the U/S room, check if there is intrauterine GS. If there is IUGS, take breath as this is most probably threatened abortion, but still there is a very small risk of heterotropic pregnancy (one baby intrauterine & another one ectopic); admit this pt. for good evaluation of adnexia by transvaginal U/S & do serial B. HCG. If the other option; there is no intrauterine GS, mostly this is ECTOPIC; do good evaluation to the adnexia to discover the intact GS. By this, you most probably diagnosed or excluded Ectopic pregnancy without any investigations yet.

Live Clinical Scenario of Ruptured Ectopic pregnancy :
A case with same or similar scenario as before but generally not well, pale, feeling faint or loss of consciousness, much more pain, distended abdomen, tenderness elsewhere, tachycardia like pulse 120/m, hypotensive like BP 80/40, by scan empty uterus with darkness intraabdominal around the uterus &adnexia, urgent CBC show low Hb& low Hct.
What Next?
– Unruptured Ectopic pregnancy : admit the pt. to ward to confirm diagnosis by transvaginal U/S & serial B.HCG every 2 days with subnormal rise (not doubling) with close observation for any symptoms or signs of rupture till confirming diagnosis for management.
– Ruptured Ectopic pregnancy : its a clinical diagnosis from the first presentation of a case with positive pregnancy test & surgical abdomen. Prepare good a mount of blood after cross matching & take the pt. for laparotomy.
How To Differentiate Clinically between Abortion and Ectopic Pregnancy