Ectopic Pregnancy (Ruptured)MANAGEMENT

OBSTETRIC PRESENTATIONS · 12 SECTIONS

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676 items

☷ Legend

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Cardiovascular Presentations71▾

Respiratory Presentations52▾

Neurological Presentations83▾

Gastrointestinal Presentations74▾

Genitourinary and Reproductive Presentations48▾

Infectious Disease Presentations148▾

Trauma Presentations89▾

Toxicologic Presentations80▾

Psychiatric Presentations26▾

Musculoskeletal and Rheumatologic Presentations96▾

Dermatology Presentations23▾

Environmental and Exposure Presentations27▾

Hematologic and Oncologic Presentations36▾

Pediatric-Specific Presentations19▾

Endocrine and Metabolic Presentations45▾

ENT and Maxillofacial Presentations27▾

Ophthalmologic Presentations19▾

Obstetric Presentations23▾

Chorioamnionitis Eclampsia Ectopic Pregnancy (Ruptured)Ectopic Pregnancy (Unruptured)HELLP Syndrome Hyperemesis gravidarum Peripartum cardiomyopathy Placenta previa Placental abruption Postpartum Endometritis Postpartum hemorrhage Postpartum infection Preeclampsia Preeclampsia-eclampsia Preterm labor Sepsis in pregnancy Septic abortion Shoulder dystocia Spontaneous Abortion (Incomplete)Spontaneous Abortion (Missed)Spontaneous Abortion (Threatened)Threatened-inevitable-incomplete abortion Umbilical cord prolapse

Systemic and Miscellaneous Presentations17▾

01Approach to the Critical Patient/attcp54

Immediate resuscitation priorities

›Airway and breathing

›Airway patent and protected

›Altered mental status from haemorrhagic shock impairs airway reflexes

›Rapid sequence intubation if airway unprotected

›Oxygen supplementation

›High-flow O2 15 L/min non-rebreather for haemorrhagic shock

›Target SpO2 >= 95%

›Circulation and haemorrhage control

›Two large-bore IV access 16-18G minimum

›Antecubital or external jugular if peripheral access fails

›Intraosseous access if IV unobtainable in extremis

›Immediate volume resuscitation

›Crystalloid bolus 1 L IV rapid infusion as bridge

›Activate massive transfusion protocol (MTP) if haemodynamically unstable

›Blood product transfusion

›Type and crossmatch as priority

›Uncrossmatched O-negative pRBCs if life-threatening haemorrhage without delay

›pRBC:FFP:platelets 1:1:1 ratio per MTP

Haemodynamic targets and monitoring

›Haemodynamic targets

›Permissive hypotension SBP 80-90 mmHg as bridge to OR

›Avoid aggressive fluid resuscitation until surgical haemostasis

›Reduces dilutional coagulopathy risk

›Heart rate target < 100 beats/min

›Persistent tachycardia indicates ongoing haemorrhage

›Urine output target >= 0.5 mL/kg/hr

›Foley catheter placement

02History/hx75

Classic presentation

›Triad of amenorrhea, vaginal bleeding, and pelvic pain

›All three present in minority of cases

›Absence of one element does not exclude diagnosis

›Last menstrual period

›Often 6-8 weeks prior

›Irregular periods may obscure history

›Vaginal bleeding

›Typically light spotting from decidual sloughing

›Rarely exceeds normal menstrual flow

›Passage of decidual cast does not rule out ectopic

›Pain characterisation

›Pre-rupture pain

›Unilateral or bilateral pelvic pain

›Dull, crampy, or sharp quality

›Rupture pain pattern

›Sudden severe generalised abdominal pain

›May initially improve briefly after rupture then worsen

›Shoulder tip pain (Kehr sign) from diaphragmatic irritation by hemoperitoneum

Alarm symptoms

›Haemodynamic compromise symptoms

›Syncope or near-syncope

›High-risk symptom in reproductive-age female

›Always triggers pregnancy test and FAST

›Dizziness and orthostatic lightheadedness

›Volume depletion indicator

›Diaphoresis

›Sympathetic activation from haemorrhagic shock

03Physical Exam/exam57

Vital signs

›Haemodynamic status

›Heart rate

›Tachycardia may be early or only sign

›HR > 100 beats/min warrants urgent evaluation

›Blood pressure

›Hypotension is a late sign in young patients

›SBP < 90 mmHg indicates advanced haemorrhagic shock

›Orthostatic vitals

›SBP drop >= 20 mmHg or HR rise >= 20 beats/min on standing

›Indicates significant volume depletion

›General appearance

›Pallor and diaphoresis

›Sympathetic activation from haemorrhage

›Altered mental status

›Late sign of severe hypovolaemia

›Delayed capillary refill > 2 seconds

Abdominal examination

›Peritoneal signs

›Diffuse abdominal tenderness

›Generalised with rupture and hemoperitoneum

›Maximal in lower quadrants and pelvis

›Rebound tenderness

›Peritoneal irritation from blood

›Strongly suggests hemoperitoneum with rupture

›Guarding and rigidity

›Involuntary guarding indicates peritonitis

›Board-like rigidity indicates extensive peritoneal irritation

04Differential Diagnosis/ddx48

Life-threatening differentials

›Ruptured ectopic pregnancy

›ICD-10 O00.9 (ectopic pregnancy unspecified)

›ICD-10 O00.1 (tubal pregnancy)

›Positive pregnancy test plus haemodynamic instability

›No IUP on TVUS plus free fluid is diagnostic until proven otherwise

›Ruptured haemorrhagic ovarian cyst

›ICD-10 N83.0

›Pregnancy test negative

›Key differentiating feature

›Hemoperitoneum possible with sudden onset pain

›Ruptured splenic artery aneurysm

›Rare but catastrophic

›Particularly in pregnancy

›Left upper quadrant and shoulder pain

›CT angiography diagnostic

Gynaecological differentials

›Ovarian torsion

›ICD-10 N83.5

›Acute unilateral colicky pelvic pain with nausea and vomiting

›Intermittent pain from torsion-detorsion cycle

›Pregnancy test may be positive or negative

›No free fluid unless cyst rupture coexists

›Threatened or incomplete miscarriage

›ICD-10 O03.4 / O20.0

›IUP confirmed on ultrasound

›Intrauterine pregnancy distinguishes from ectopic

›Cervical os typically open in incomplete miscarriage

05Laboratory Tests/lt43

Core labs

›Quantitative serum beta-hCG

›Confirms pregnancy

›Ruptured ectopic can occur at any beta-hCG level including very low values

›Level does not reliably predict presence or absence of rupture

›Discriminatory zone concept

›beta-hCG > 3,500 mIU/mL with no IUP on TVUS highly suggestive of ectopic

›Rupture can occur well below this threshold

›Do not use discriminatory zone to delay surgery in unstable patient

›Complete blood count

›Haemoglobin and haematocrit

›Baseline value before resuscitation

›Lower preoperative haemoglobin associated with rupture

›Serial CBC to track ongoing haemorrhage

›Platelet count

›Thrombocytopaenia develops with massive transfusion and DIC

›Leucocyte count

›Mild leukocytosis expected from haemorrhagic stress

Type and screen / crossmatch

›Blood bank orders

›Type and screen minimum

›Identify blood group and antibodies

›Type and crossmatch 2-4 units pRBCs

›If haemodynamically unstable or haemorrhage anticipated

›Rh typing

›Determines RhoGAM (anti-D immunoglobulin) requirement

›Rh-negative patients require anti-D 300 mcg IM

06Diagnostic Tests/dt78

Scoring Systems

›Shock Index

›Heart rate divided by systolic blood pressure

›Shock Index > 1.0 indicates significant haemodynamic compromise

›Shock Index > 1.5 predicts need for massive transfusion

›Simple bedside tool applicable without labs

›Serial measurement tracks response to resuscitation

›Pregnancy of Unknown Location (PUL) classification

›Applies to stable patients only

›Not applicable when haemodynamically unstable

›Risk stratification for expectant vs intervention

›M4P score and M-value systems

›Serial beta-hCG trending used in stable PUL

›Ruptured ectopic bypasses PUL protocols

›Proceed directly to definitive surgical management

MRI

›MRI role in ectopic pregnancy

›Rarely indicated in acute management

›Time and availability constraints prohibitive in emergency

›Unstable patient is a contraindication

›Selected non-tubal ectopic locations

›Interstitial or cornual ectopic

›Cervical ectopic

›Abdominal or ovarian ectopic

›Caesarean scar ectopic localisation

›MRI advantages for non-tubal ectopic

›Superior soft tissue characterisation

›Defines anatomical relationship to adjacent structures

›Guides surgical or interventional planning

›CT abdomen and pelvis

›Indications in ectopic pregnancy

›Not first-line investigation

›Ectopic not initially suspected on clinical presentation

›Atypical presentations where diagnosis unclear

›CT findings in ruptured ectopic

›Free intraperitoneal fluid (haemoperitoneum)

›Adnexal mass or complex extrauterine structure

›Active extravasation with contrast (vascular blush)

›Empty uterus

›Contrast considerations

›IV contrast preferred for vascular assessment

›Renal function assessment before contrast in stable patient

›Radiation exposure counselling

›Benefit of diagnosis outweighs fetal radiation risk in acute emergency

›ACR Appropriateness Criteria support CT for acute pelvic pain when TVUS non-diagnostic (2023 update)

›CT angiography

›Indicated when vascular ectopic suspected

›Interstitial or cornual location with active haemorrhage

›Guides uterine artery embolisation planning in selected stable cases

Ultrasound

›Transvaginal ultrasound (TVUS)

›First-line diagnostic modality for suspected ectopic

›Single best diagnostic test

›ACOG Practice Bulletin 193 supports TVUS as primary imaging

›Key diagnostic findings

›Empty uterine cavity

›Adnexal mass separate from ovary (tubal ring sign)

›Free fluid in cul-de-sac (anechoic) or hemoperitoneum (echogenic)

›Echogenic free fluid (clotted blood) more concerning than anechoic

›Sensitivity and specificity

›Sensitivity 87-99% for tubal ectopic when performed by experienced operator

›Specificity > 99% when IUP definitively excluded

›TVUS limitations

›Operator dependent

›Heterotopic pregnancy may show IUP and concurrent ectopic

›Bedside POCUS and FAST

›Free fluid identification in haemodynamically unstable patient

›Morison's pouch (hepatorenal)

›Splenorenal recess

›Perivesical space

›Pericardial window

›Do not delay OR for formal imaging if FAST shows free fluid with positive pregnancy test

›ACEP supports POCUS for early identification of hemoperitoneum

›Transabdominal ultrasound supplement

›Quantify extent of free fluid in upper abdomen

›Useful when TVUS technically limited

›Doppler assessment

›Peritrophoblastic flow (ring of fire sign)

›Increased vascularity around ectopic sac on colour Doppler

›Supports but not required for diagnosis

›Absence of IUP Doppler flow does not exclude early IUP

07Disposition/dispo42

Operative disposition

›All ruptured ectopic pregnancies require immediate operative disposition

›Direct OR activation without delay

›OB/GYN surgeon notification at diagnosis

›Do not admit to ward if haemodynamically unstable

›Pre-operative checklist

›NPO status confirmed

›Foley catheter placed

›Resuscitation ongoing en route to OR

›Informed consent when feasible

›Post-operative admission

›Routine post-operative monitoring ward

›Stable haemodynamics post-operatively

›Uncomplicated laparoscopic salpingectomy

›ICU or high-dependency unit

›Massive haemorrhage requiring multiple transfusions

›Ongoing haemodynamic instability post-operatively

›Developing DIC

›Respiratory or renal complications

Transfer criteria

›Transfer indications

›Facility lacks OB/GYN surgical capability

›Initiate resuscitation prior to transfer

›Maintain haemodynamic support during transport

›Two large-bore IVs and blood products for transport

›No operating room availability

›Emergent transfer to nearest surgical centre

›Transfer safety threshold

08Treatment/t90

Immediate stabilisation

›Resuscitation bundle

›IV access

›Two large-bore peripheral IVs 16-18G

›Intraosseous if peripheral IV unobtainable in < 90 seconds

›Fluid resuscitation

›Normal saline or lactated Ringer's 1 L IV bolus

›Limit crystalloid to minimise dilutional coagulopathy

›Switch to blood products as soon as available

›NPO status

›Immediate NPO for anticipated surgical intervention

›Foley catheter placement

›Urine output monitoring

›Target >= 0.5 mL/kg/hr

›Massive transfusion protocol (MTP)

›Activation criteria

›Haemodynamic instability despite initial crystalloid bolus

›Estimated blood loss > 1,500 mL or ongoing haemorrhage

›Shock Index > 1.0 with haemoperitoneum

›pRBC transfusion

›Uncrossmatched O-negative pRBCs if life-threatening haemorrhage without delay

›Target haemoglobin >= 70-80 g/L (7-8 g/dL) in haemodynamically stable post-op

›FFP and platelets

›1:1:1 ratio pRBC:FFP:platelets per MTP

›FFP 10-15 mL/kg IV

›Platelet transfusion target > 50 x 10^9/L intraoperatively

›Cryoprecipitate

›Target fibrinogen > 1.5 g/L

›Cryoprecipitate 10 units IV if fibrinogen < 1.5 g/L

›Tranexamic acid

›1 g IV over 10 minutes within first 3 hours of haemorrhage onset

›Repeat dose 1 g IV if ongoing haemorrhage at 30 minutes

›Class I recommendation for haemorrhagic shock with antifibrinolytic benefit

Definitive surgical treatment

›Laparoscopic salpingectomy (preferred approach)

›Indications

›Haemodynamically stable or rapidly stabilised

›Surgeon experienced in laparoscopic technique

›Ruptured tube with hemoperitoneum

›Advantages over laparotomy

›Shorter recovery time

›Less blood loss

›Equivalent outcomes to laparotomy in experienced hands

›ACOG Practice Bulletin 193 supports laparoscopy as preferred surgical approach

›Salpingectomy vs salpingostomy

›Salpingectomy preferred for ruptured tube

›Salpingostomy may be considered if contralateral tube damaged or absent

›Salpingostomy carries higher risk of persistent trophoblast requiring post-operative monitoring

›Laparotomy indications

›Massive haemorrhage with cardiovascular instability precluding laparoscopy

›Dense adhesions from prior surgery

›Surgeon preference or facility limitations

›Interstitial or cornual ectopic requiring uterine repair

›Intraoperative haemorrhage control

›Direct surgical haemostasis priority

›Salpingectomy removes bleeding source

›Cell salvage consideration in non-infected field

›Autologous blood conservation when significant haemoperitoneum

Adjunctive medications

›RhoGAM (anti-D immunoglobulin)

›All Rh-negative patients with ectopic pregnancy regardless of rupture status

›Standard dose 300 mcg IM

›Administer within 72 hours of haemorrhage event

›Prevents Rh sensitisation from feto-maternal haemorrhage

›Analgesia

›IV opioids for pain control

›Morphine 2-4 mg IV titrated to effect every 5-10 minutes

›Hydromorphone 0.2-0.4 mg IV as alternative

›Avoid NSAIDs if coagulopathy suspected

›Platelet inhibition worsens haemostasis

›Anaesthesia management for OR

›Rapid sequence induction for full stomach

›Ketamine 1-2 mg/kg IV for haemodynamically unstable induction

›Avoid propofol induction if haemodynamically compromised

›Vasopressors (bridge to OR)

›Norepinephrine 0.01-0.5 mcg/kg/min IV for refractory hypotension

›Bridge to surgical haemostasis only

›Do not delay OR for vasopressor titration

›Vasopressin 0.03-0.04 units/min as adjunct

Post-operative care

›Post-operative monitoring

›Vital signs and urine output hourly initially

›Serial haemoglobin at 4-6 hours post-operatively

›Coagulation panel if MTP was activated

›Beta-hCG monitoring post-operatively

›Serial weekly beta-hCG until undetectable (< 5 mIU/mL)

›Particularly important after salpingostomy

›Persistent trophoblast requires methotrexate rescue

›Single dose methotrexate 50 mg/m2 IM for persistent trophoblast after salpingostomy

›Psychological support

›Mental health screening for grief, anxiety, PTSD

›Pregnancy loss and ectopic carry significant psychological burden

›Referral to counselling or perinatal loss support services

›Often underrecognised as significant psychological event

09Special Populations/sp50

Pregnancy

›Heterotopic pregnancy considerations

›Coexisting intrauterine and ectopic pregnancy

›Spontaneous rate approximately 1:30,000

›IVF rate up to 1:100 with ovarian hyperstimulation

›IUP on TVUS does not exclude concurrent ectopic

›Clinical suspicion must remain high in IVF patients with pain

›Treatment is surgical salpingectomy with IUP preservation

›Progesterone supplementation for IVF pregnancies

›Continue post-operatively if heterotopic IUP viable

›Advanced maternal age and ectopic risk

›Age > 35 years associated with increased ectopic risk

›Declining tubal function and increased adhesion burden

›Higher-order multiple pregnancy risk with ART

›Baseline cardiovascular reserve may differ

Geriatric

›Ectopic pregnancy in perimenopausal women

›Reproductive capability extends to menopause

›Irregular menses may obscure amenorrhea history

›Always obtain pregnancy test in reproductive-age female regardless of perceived age

›Atypical presentation more common

›Shoulder pain may be attributed to musculoskeletal cause

›Subtle haemodynamic compromise may be masked by baseline hypertension

›Comorbidities increase surgical risk

›Pre-existing cardiovascular disease reduces haemorrhagic reserve

›Anticoagulant or antiplatelet medication use

›Renal impairment affects fluid management

›Anaesthetic considerations

10Background/b81

Epidemiology

›Incidence and mortality

›Ectopic pregnancy accounts for 1-2% of all pregnancies

›Approximately 11.7 per 1,000 pregnancies in developed countries

›Ruptured ectopic accounts for 2.7% of pregnancy-related deaths

›Leading cause of maternal mortality in first trimester

›Tubal ectopic accounts for approximately 95% of all ectopic pregnancies

›Fallopian tube is most common site

›Non-tubal locations include ovarian, interstitial, cervical, abdominal, caesarean scar

›Incidence trends

›Incidence increased in recent decades

›Increased STI rates and sequelae

›Increased ART utilisation

›Improved diagnosis of previously unrecognised cases

›Age distribution peaks 25-34 years

›Risk increases with age due to cumulative tubal damage

›Morbidity and mortality statistics

›Case fatality rate approximately 0.5 per 1,000 estimated ectopic pregnancies in high-income countries

›Haemorrhagic shock primary cause of death

›Delay in diagnosis most preventable contributor to mortality

›Recurrent ectopic risk approximately 6-7% after first ectopic

›Future live birth rate 45-52% depending on treatment modality

Pathophysiology

›Implantation mechanism

›Failure of ovum transport to uterus

›Tubal cilia dysfunction from inflammation or scarring

›Anatomical obstruction from adhesions or prior surgery

›Trophoblast invasion of non-uterine tissue

›Invasive trophoblast erodes through tubal wall

›Progressive haemorrhage as vessels are invaded

›Rupture mechanism

›Growing gestational sac exceeds tubal capacity

›Typically occurs 6-10 weeks gestation for ampullary ectopic

›Isthmic ectopic may rupture earlier due to narrow lumen

›Interstitial ectopic may present at 10-16 weeks due to myometrial support

›Rupture pattern

›Sudden haemorrhage from eroded tubal vessels

›Free haemoperitoneum causes peritoneal irritation

›Diaphragmatic irritation by blood causes Kehr sign (shoulder tip pain)

›Haemodynamic consequences

›Haemoperitoneum from ruptured tubal vessels

›Blood loss may exceed 2-3 L into peritoneal cavity

›Haemorrhagic shock class III-IV with significant haemorrhage

›DIC risk with massive haemorrhage

›Dilutional coagulopathy from transfusion

›Tissue factor release from placental tissue

Therapeutic Considerations

›Surgical principles

›Surgery is the only definitive treatment for ruptured ectopic

›Methotrexate absolutely contraindicated in ruptured ectopic

›Expectant management not appropriate for rupture

›Laparoscopy vs laparotomy decision

›Laparoscopy preferred when surgeon skilled and patient stabilisable

›Laparotomy faster in extreme haemodynamic instability

›Equivalent fertility outcomes with experienced laparoscopic surgeon

›Salpingectomy vs salpingostomy evidence

›Salpingectomy

›Removes ectopic completely

›No risk of persistent trophoblast

›Preferred when contralateral tube normal

›Salpingostomy

›Linear incision with ectopic removal preserving tube

›Persistent trophoblast rate 3-20% requiring methotrexate rescue

›Consider when contralateral tube absent or severely damaged

›Future fertility outcomes similar between salpingectomy and salpingostomy

›Population-based cohort data (Rosen et al. AJOG 2025)

›Haemostatic resuscitation evidence

›Early balanced transfusion reduces mortality in haemorrhagic shock

›1:1:1 pRBC:FFP:platelets supported by PROPPR trial (JAMA 2015)

›Tranexamic acid reduces mortality in haemorrhagic shock

›WOMAN trial (Lancet 2017) showed reduction in death from haemorrhage in postpartum haemorrhage

›Extrapolated to ectopic haemorrhage management

›Damage control surgery principles applicable

›Abbreviated surgical procedure to achieve haemostasis

›ICU resuscitation before definitive reconstruction if needed

›Methotrexate indications (stable unruptured ectopic only)

›Contraindicated in ruptured ectopic

›Indications for stable unruptured ectopic

›Haemodynamically stable

›Beta-hCG < 5,000 mIU/mL

›No fetal cardiac activity on TVUS

›Gestational sac < 4 cm diameter

›Reliable follow-up access

›No absolute contraindications (hepatic/renal/haematological disease, breastfeeding, immunodeficiency)

11Patient Discharge Instructions/pdi43

copy discharge instructions

›Post-operative recovery instructions

›Activity restrictions

›Pelvic rest and no heavy lifting > 5 kg for 2 weeks after laparoscopy

›No driving while taking opioid pain medication

›Graduated return to normal activities over 2 weeks for laparoscopy

›Full recovery after laparotomy may take 4-6 weeks

›Wound care

›Keep laparoscopic port sites clean and dry

›Non-adhesive dressing changes as instructed

›No submerging in bath, pool, or ocean for 2 weeks

›Pain management at home

›Ibuprofen 400-600 mg every 6-8 hours with food for mild pain

›Paracetamol 500-1000 mg every 6 hours as alternative

›Prescribed opioids only as directed and for limited duration

›Medications and follow-up

›RhoGAM already administered if Rh-negative

›No further action required for this

›Beta-hCG blood test schedule

›Weekly blood tests until beta-hCG undetectable

›Clinic will contact with results and further instructions

›OB/GYN follow-up appointment

›Within 1-2 weeks post-operatively

›Bring list of current medications

›Future pregnancy information

›When it is safe to try again

›Recommended to wait at least 1 menstrual cycle

›If methotrexate was used wait minimum 3 months before conception

12References/r15

Guidelines and key sources

›Primary guidelines

›ACOG Practice Bulletin No. 193: Tubal Ectopic Pregnancy. Obstetrics and Gynecology. 2018. doi:10.1097/AOG.0000000000002560

›ACR Appropriateness Criteria: First Trimester Vaginal Bleeding 2025 Update. Journal of the American College of Radiology. 2025

›ACR Appropriateness Criteria: Acute Pelvic Pain in the Reproductive Age Group 2023 Update. Journal of the American College of Radiology. 2024

›Key clinical studies

›Hendriks E, Rosenberg R, Prine L. Ectopic Pregnancy: Diagnosis and Management. American Family Physician. 2020. PMID 32412215

›Chong KY, de Waard L, Oza M, et al. Ectopic Pregnancy. Nature Reviews Disease Primers. 2024. PMID 39668167

›Crochet JR, Bastian LA, Chireau MV. Does This Woman Have an Ectopic Pregnancy? JAMA Rational Clinical Examination. 2013. doi:10.1001/jama.2013.3914

›Barnhart KT. Ectopic Pregnancy. New England Journal of Medicine. 2009. doi:10.1056/NEJMcp0810384

›Schreiber CA, Sonalkar S. Tubal Ectopic Pregnancy. New England Journal of Medicine. 2025. doi:10.1056/NEJMcp2402787

›Jeffers K, Koyfman A, Long B. Updates in Emergency Medicine: Ectopic Pregnancy. American Journal of Emergency Medicine. 2024. PMID 39244808

›Rosen A, Palma L, Ordon M, et al. Pregnancy Outcomes Following Medical Versus Surgical Treatment of Tubal Ectopic Pregnancy. American Journal of Obstetrics and Gynecology. 2025. PMID 40645471

›Farren J, Al Wattar BH, Jurkovic D. Diagnosis and Management of Extrauterine and Uterine Ectopic Pregnancy. Human Reproduction Update. 2025. PMID 41061761

›Li PC, Lin WY, Ding DC. Risk Factors and Clinical Characteristics Associated with Ruptured Ectopic Pregnancy: 19-Year Retrospective Study. Medicine. 2022. PMID 35713461

›Yuan F, Cui ZC, Jiang ZZ, Liu XT. Acute Pelvic Pain in High-Altitude Tourist: Ruptured Ectopic With Low beta-hCG. Medicine. 2025. PMID 41465890

Learn More: Ectopic Pregnancy (Ruptured)→

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Reviewed by SymptomDx Medical Team · Last reviewed August 18, 2026

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