Dawaa Reference

Clinical reference

Ectopic pregnancy

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources3 sources

Ectopic Pregnancy - StatPearls (NCBI Bookshelf NBK539860) - https://www.ncbi.nlm.nih.gov/books/NBK539860/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class WD69 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care

Verified against1 document
  • No dose - referral pathway, no medicine given in primary care

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (12)

  • Ectopic pregnancy often starts as colicky abdominal or pelvic pain localized to one side [abdominal pain · pelvic pain]
  • Shoulder pain, urinary symptoms, and rectal pressure can occur, along with dizziness, fainting, nausea, and vomiting [dizziness · joint pain · nausea · shoulder pain · syncope · vomiting]
  • A missed period or abnormal uterine bleeding raises suspicion of pregnancy, including a possible ectopic [abnormal uterine bleeding]
  • A cesarean scar ectopic pregnancy can range from silent, found on routine ultrasound, to presenting as uterine rupture [scarring]
  • The usual picture is lower abdominal pain, typically on one side, together with vaginal bleeding [abdominal pain · lower abdominal pain · vaginal bleeding]
  • Shoulder pain, fainting, dizziness, or pain in the pelvis that is severe, are the features that mean it may already have ruptured [abdominal pain · dizziness · joint pain · pelvic pain · shoulder pain · syncope]
  • It complicates about 1% to 2% of pregnancies
  • It causes 2.7% of all pregnancy-related deaths, so it is a condition that kills
  • The tubal damage behind it comes from previous gonorrhoea or chlamydia, tubal surgery including sterilisation, a previous ectopic, or diethylstilbestrol exposure before birth
  • Conceiving with an intrauterine device in place, or while on a progesterone-only contraceptive, is a further risk factor
  • Rarely it implants outside the tube altogether - in the cervix, an ovary, the abdomen, a uterine cornu, or a caesarean scar [scarring]
  • Those extratubal ones are less likely to carry any of the usual risk factors or any tubal disease, which makes both diagnosis and management harder

Signs — what you find (3)

  • Tachycardia and hypotension on exam signal hemodynamic instability [hypotension · tachycardia]
  • Abdominal guarding on palpation raises concern for free fluid from a ruptured ectopic pregnancy or peritonitis [guarding]
  • Bimanual exam may reveal an adnexal mass or tenderness [pelvic mass]

Tests (7)

  • A beta-hCG over 2000 mIU/mL with no intrauterine pregnancy seen on ultrasound strongly suggests an ectopic pregnancy
  • A viable intrauterine pregnancy with an initial beta-hCG under 1500 mIU/mL typically rises at least 49% over 48 hours
  • A slower rise, or a fall of at least 21% over 48 hours, points toward miscarriage or ectopic pregnancy
  • ACOG suggests a discriminatory beta-hCG cutoff of up to 3500 mIU/mL before expecting to see an intrauterine pregnancy
  • Transvaginal ultrasound is the gold standard, confirmed when a yolk sac or embryo is seen outside the uterus
  • The double decidual sign of an early intrauterine pregnancy is typically visible by the fifth week
  • MRI can help in select cases, such as a large uterine fibroid obscuring the ultrasound view

If not this — what else fits (9)

  • Ovarian torsion
  • Tubo-ovarian abscess
  • Appendicitis
  • Hemorrhagic corpus luteum
  • Ovarian cyst rupture
  • Threatened miscarriage
  • Incomplete miscarriage
  • Pelvic inflammatory disease
  • Ureteral calculi

SourceStatPearls "Ectopic Pregnancy" - disease-level clinical article

Presentation findings are traced to the source above.

1

NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE)

1st line
Adult dose and duration

A life-threatening pregnancy complication; the GP must recognise the presentation (missed period, pain, bleeding) and refer immediately as an emergency. Methotrexate is a specialist-directed option in select stable cases and is not typically started in general practice. - Refer, with advice

Paediatric dose

Adult-only condition - paediatric section not applicable

Dose source

No dose - referral pathway, no medicine given in primary care

Why

A life-threatening pregnancy complication; the GP must recognise the presentation (missed period, pain, bleeding) and refer immediately as an emergency. Methotrexate is a specialist-directed option in select stable cases and is not typically started in general practice.

Cautions
  • Severe abdominal pain, shoulder-tip pain, dizziness, or collapse in a woman of reproductive age with a positive pregnancy test suggests a ruptured ectopic pregnancy - a surgical emergency.
  • No medicine is prescribed for this in primary care - this entry is for recognition and referral. Anything given is decided by the service it is referred to.

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.