Ectopic Pregnancy Differential Diagnoses

Updated: Sep 28, 2017
  • Author: Vicken P Sepilian, MD, MSc; Chief Editor: Michel E Rivlin, MD  more...
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DDx

Diagnostic Considerations

Only 50% of patients with an ectopic pregnancy present with the classic triad of pain, amenorrhea, and vaginal bleeding. Numerous conditions may have a presentation similar to an extrauterine pregnancy. The most common of these include the following:

  • Appendicitis

  • Salpingitis

  • Ruptured corpus luteum cyst or ovarian follicle

  • Spontaneous abortion or threatened abortion

  • Ovarian torsion

  • Urinary tract disease

Intrauterine pregnancies with other abdominal or pelvic problems, such as degenerating fibroids, must also be included in the differential diagnosis.

A study by Huchon et al found that the following 4 symptoms independently contributed to the diagnosis of tubal rupture:

  • Vomiting during pain

  • Diffuse abdominal pain

  • Acute pain for longer than 30 minutes

  • Flashing pain

The sensitivity was 93% in the presence of 1 or more of these items, and the specificity was 44%, with a negative likelihood ratio for ruling out tubal rupture of 0.16. [54]

The following conditions should also be considered in the differential diagnosis of ectopic pregnancy:

  • Postabortion bleeding

  • Retained products of abortion

  • Molar pregnancy

  • Cornual myoma or abscess

  • Ovarian tumor

  • Endometrioma

  • Cervical phase of uterine abortion

Differential Diagnoses