Ectopic pregnancy: Clinical manifestations and diagnosis INTRODUCTION — An ectopic pregnancy (thai tử cung) is an extrauterine (ngoài tử cung) pregnancy Almost all ectopic pregnancies occur in the fallopian tube (ống dẫn trứng) (98 percent), but other possible sites include: cervical (cổ tử cung), interstitial (đoạn kẽ), ovarian (buồng trứng), or abdominal (ổ bụng) The diagnosis (chẩn đoán) of ectopic pregnancy is based upon a combination of measurement of the serum quantitative human chorionic gonadotropin (hCG) and findings on transvaginal ultrasonography (siêu âm đầu dò âm đạo) (TVUS) CLINICAL PRESENTATION — The most common clinical presentation (dấu hiệu lâm sàng) of ectopic pregnancy is first trimester (3 tháng đầu thai kỳ) vaginal bleeding (xuất huyết âm đạo) and/or abdominal pain Ectopic pregnancy may also be asymptomatic (không triệu chứng) Normal pregnancy discomforts (khó chịu thai kỳ) (eg, breast tenderness (vú căng đau), frequent urination (tiểu nhiều lần), nausea (buồn nôn)) are sometimes present in addition to the symptoms specifically associated with ectopic pregnancy There may be a lower likelihood of early pregnancy symptoms, because progesterone, estradiol, and human chorionic gonadotropin (hCG) may be lower in ectopic pregnancy than in normal pregnancy In a retrospective study (nghiên cứu hồi cứu) of 2026 pregnant women who presented to the emergency department (khoa cấp cứu) with first trimester vaginal bleeding and abdominal pain, 376 (18 percent) were diagnosed with ectopic pregnancy Of these 376 women, 76 percent had vaginal bleeding and percent had abdominal pain In a population-based registry of ectopic pregnancy from France, the incidence of rupture was 18 percent Clinical manifestations of ectopic pregnancy typically appear six to eight weeks after the last normal menstrual period (chu kỳ kinh cuối bình thường), but can occur later, especially if the pregnancy is in an extrauterine site other than the fallopian tube An ectopic pregnancy may be unruptured or ruptured at the time of presentation to medical care Tubal rupture can result in life-threatening hemorrhage (xuất huyết đe dọa tử vong) Any symptoms suggestive of rupture should be noted These include severe or persistent abdominal pain or symptoms suggestive of ongoing blood loss (eg, feeling faint or loss of consciousness) Based upon the concern about the risk of rupture at the time or after presentation, clinicians should consider ectopic pregnancy as a diagnosis in any woman of reproductive age (độ tuổi sinh sản) with vaginal bleeding and/or abdominal pain who has the following characteristics: (1) pregnant, but does not have a confirmed intrauterine pregnancy (IUP); (2) pregnancy status uncertain, particularly if amenorrhea (vô kinh) of >4 weeks preceded the current vaginal bleeding; (3) in rare cases, a woman who presents with hemodynamic instability and an acute abdomen that is not explained by another diagnosis Vaginal bleeding — The amount and timing of vaginal bleeding vary and there is no bleeding pattern that is pathognomonic for ectopic pregnancy Bleeding may range from scant brown staining to hemorrhage Bleeding is typically intermittent, but may occur as a single episode or continuously The vaginal bleeding associated with ectopic pregnancy is typically preceded by amenorrhea However, some women may misinterpret bleeding as normal menses, and may not realize they are pregnant prior to developing symptoms associated with ectopic pregnancy This is particularly true in women who have irregular menses (chu kỳ kinh không đều) or who not keep track of menstrual cycles (chu kỳ kinh) Bleeding occurs in many other conditions in early pregnancy (giai đoạn sớm thai kỳ) Abdominal pain — The pain associated with ectopic pregnancy is usually located in the pelvic area (vùng chậu) It may be diffuse or localized to one side In cases in which there is intraperitoneal blood that reaches the upper abdomen or in rare cases of abdominal pregnancy (thai ổ bụng), the pain may be in the middle or upper abdomen If there is sufficient intraabdominal bleeding (xuất huyết ổ bụng) to reach the diaphragm, there may be referred pain that is felt in the shoulder Blood pooling in the posterior cul-de-sac (pouch of Douglas) may cause an urge to defecate The timing, character, and severity of abdominal pain vary, and there is no pain pattern that is pathognomonic for ectopic pregnancy The onset of the pain may be abrupt or slow, and the pain may be continuous or intermittent The pain may be dull or sharp; it is generally not crampy The pain may be mild or severe Tubal rupture (vỡ khối thai ống dẫn trứng) may be associated with an abrupt onset of severe pain, but rupture may also present with mild or intermittent pain Trimester: tam cá nguyệt → First trimeseter (Tam cá nguyệt – tháng đầu thai kỳ) – Second trimester – Third trimester Bleeding: xuất huyết Vaginal bleeding: xuất huyết âm đạo – Uterine bleeding: xuất huyết tử cung ... kinh) Bleeding occurs in many other conditions in early pregnancy (giai đoạn sớm thai kỳ) Abdominal pain — The pain associated with ectopic pregnancy is usually located in the pelvic area (vùng... timing of vaginal bleeding vary and there is no bleeding pattern that is pathognomonic for ectopic pregnancy Bleeding may range from scant brown staining to hemorrhage Bleeding is typically intermittent,... intermittent, but may occur as a single episode or continuously The vaginal bleeding associated with ectopic pregnancy is typically preceded by amenorrhea However, some women may misinterpret bleeding