Lower tummy/abdominal pain and/or bleeding during pregnancy may be due to a number of causes. It is however very important that an ectopic pregnancy as the cause is excluded. If not diagnosed and treated quickly an ectopic pregnancy can lead to internal bleeding and a medical emergency. Show
Some experience symptoms that are similar to other conditions such as gastroenteritis (tummy bug), urinary tract infection (UTI), pelvic inflammatory disease (PID) and miscarriage, which are the most common ways to misdiagnose an ectopic pregnancy. Not all experience symptoms. When ectopic pregnancy symptoms startThe diagnosis of ectopic pregnancy may sometimes be difficult, and symptoms may occur from as early as 4 weeks pregnant and up to 12 weeks or even later. In addition, although there are a number of recognised risk factors, in over 50% of women diagnosed with an ectopic pregnancy, there are no identifiable risk factors. See the reasons for an ectopic pregnancy page for more information. If your instincts are screaming at you that something does not feel right, it is OK to trust them and ask for reassessment at any time. Please do be vigilant and take any pain that concerns you seriously until absolutely proven otherwise. If you are experiencing any of the following ectopic pregnancy symptoms, please contact your doctor/GP or your local Early Pregnancy Unit. You can also call the NHS Direct 111 service by dialling 111 or access the NHS GP at Hand service. You can contact your out-of-hours doctor/GP service if your normal surgery is closed or go to your local Accident and Emergency department (A&E) or Urgent Care Centre. You can also view all the options for gaining professional help here. What does ectopic pregnancy pain feel like?Ectopic pregnancy pain can be on one side of the tummy, or lower abdomen, or in the pelvic area, or at the tip of the shoulder. Experiencing these pains during early pregnancy may mean that you could be experiencing ectopic pregnancy. Consult an emergency healthcare professional immediately. What are the chances of a woman or pregnant person having an ectopic pregnancy?The risk of ectopic pregnancy is not uncommon – around 1 in 80 pregnancies are ectopic. This is when the fertilised egg implants itself outside of the womb, most commonly in a Fallopian tube, but other sites can be on an ovary, within a Caesarean section scar, or in the cervix. Deciding whether your symptoms are getting worseIt can be difficult to know which symptoms are concerning. Are they symptoms of an ectopic pregnancy or normal pregnancy sensations? If you are at worried, you should seek medical advice. Contact your doctor/GP or local Early Pregnancy Unit for advice. Your GP will likely refer you to your local Early Pregnancy Unit for an assessment by a healthcare professional. This may involve a blood test to check hormone levels and/or an ultrasound scan depending on how many weeks pregnant you are and your symptoms. It is important to remember that normal pregnancy symptoms are common and that not everyone experiencing such symptoms will have an ectopic pregnancy. It could still be a viable, healthy pregnancy. However, it is important to be vigilant. If in doubt, seek medical attention and advice from healthcare professionals. Ectopic Pregnancy Symptoms Checker
Case Report | Open Access Academic Editor: Vasileios Papadopoulos Received14 Jun 2016 Accepted18 Aug 2016 Published07 Sept 2016 A negative urine pregnancy test in the emergency department traditionally excludes the diagnosis of pregnancy. We report a rare case of ruptured ectopic pregnancy in a patient with a negative urine pregnancy test but with a serum beta-human chorionic gonadotropin (β-hCG) of 10 mIU/mL. The patient developed hemoperitoneum and required laparoscopy by Obstetrics and Gynecology (OB/Gyn). This case highlights the fallibility of the urine pregnancy test in diagnosing early pregnancy. 1. IntroductionEctopic pregnancy remains a leading cause of death in women of childbearing age in the United States [1, 2]. Women at highest risk include those less than 25 years of age and of nonwhite ethnicity [1, 2]. In the emergency department (ED), the prompt identification of a pregnant woman with an ectopic pregnancy is critical because the sudden rupture of a fallopian tube can lead to hemorrhagic shock [1, 2]. In addition, early diagnosis may allow for nonoperative intervention and preservation of fertility. The classic triad for an ectopic pregnancy of abdominal pain, amenorrhea, and vaginal bleeding is only present in about 50% of women with this condition. 2. Case PresentationA 35-year-old woman with a past medical history of bipolar affective disorder, anxiety, hemorrhoids, and polysubstance abuse presented to the ED with the chief complaint of rectal discomfort. She had two days of diffuse abdominal pain radiating to the lower back, dyspareunia, dyschezia, and nausea without vomiting. She denied urinary complaints, vaginal discharge, or bleeding. Her last menstrual period was four weeks before. Her physical exam—including pelvic, rectal, and abdominal exam—was unremarkable, and her vital signs were stable. Urinalysis, complete blood count (CBC), basic metabolic panel (BMP), and a vaginal wet prep were all within normal limits. Her urine pregnancy test was “weakly positive” and her serum β-hCG was 23 mIU/mL. A pelvic ultrasound showed no evidence of a gestational sac and was otherwise unremarkable. She was diagnosed with early pregnancy and constipation and referred for serial β-hCG measurements and repeat pelvic imaging. She returned to our ED three days later with complaints of worsening abdominal pain, increasing nausea, and dysuria. She denied vaginal bleeding. Physical exam revealed stable vitals, severe diffuse abdominal pain with guarding, cervical motion tenderness, and bilateral adnexal tenderness without palpable masses. Her urine pregnancy test was negative but her serum β-hCG was 10 mIU/mL. Her hemoglobin had dropped from 13.2 g/dL three days earlier to 10.8 g/dL. Figure 1 shows the repeat pelvic ultrasound images, demonstrating a large complex fluid collection in the pelvic cul-de-sac, possibly representing a hemorrhage without evidence of an intrauterine pregnancy. OB/Gyn emergently took the patient to the operating room for laparoscopy where she was diagnosed with hemoperitoneum and ruptured ectopic pregnancy. Gestational tissue was identified during the surgery. Her postoperative recovery was unremarkable. 3. DiscussionDiagnosing a ruptured ectopic pregnancy with a negative urine pregnancy test is exceptionally rare and only a few cases have been reported in the literature [3–8]. The following list summarizes reported cases of ectopic pregnancies with negative urine pregnancy tests. Published reports involving ruptured ectopic pregnancy and a negative urine -hCG test are as follows:Lee and Lamaro, 2009 [3]: 25-year-old with a β-hCG of 4 IU/L.Pabon et al., 2011 [4]: 34-year-old with a β-hCG of 6 IU/L.Nishijima et al., 2005 [5]: 32-year-old with a β-hCG of 1.84 IU/L.Kalinski and Guss, 2002 [6]: 44-year-old with a β-hCG of 7 IU/L.Brennan et al., 2000 [7]: 23- and 28-year-old, both with β-hCG levels of less than 25 IU/L.Grynberg et al., 2009 [8]: 26-year-old with both negative urine and serum β-hCG tests.Daniilidis et al., 2014 [9]: 36-year-old with a β-hCG of 13 IU/L.Approximately 1% of ectopic pregnancies will have a negative urine pregnancy test and a β-hCG level of less than 20 mIU/mL. The emergency physician must remain cognizant of this potential diagnosis in the setting of unexplained intraabdominal hemorrhage or severe pelvic pain with a negative urine pregnancy test [2, 4]. In a normal intrauterine pregnancy, trophoblasts will secrete β-hCG with blood levels reaching 50–300 mIU/mL within two weeks of fertilization [10]. The urine pregnancy test will generally become positive when the serum β-hCG is greater than or equal to 25 mIU/mL [10]. In a normal early intrauterine pregnancy, the β-hCG level doubles approximately every 48–72 hours until about 60–90 days after conception [9]. Only 15% of women with ectopic pregnancies will have serum β-hCG levels that rise in a way similar to normal intrauterine pregnancies [9]. The most likely mechanism for low β-hCG levels in ectopic pregnancy is the degeneration of trophoblasts that result in cessation of β-hCG production [4]. Other causes can include a small number of chorionic villi present to produce β-hCG, abnormal β-hCG synthesis, or an enhanced β-hCG clearance [4]. A woman with an aborted pregnancy will have her β-hCG levels decreasing by approximately one-half in 48 hours and going to zero within several days [8]. Clinicians should not use the β-hCG level to determine the need for an ultrasound if a pregnant female has symptoms that may be consistent with an ectopic pregnancy. In one study, approximately 25% of pregnant women in the ED presenting with abdominal pain and/or vaginal bleeding were diagnosed with an ectopic pregnancy and a β-hCG less than 1500 mIU/mL, which has been the traditional β-hCG level at which an intrauterine pregnancy can be seen on ultrasound [11]. In a retrospective study of ectopic pregnancies, the authors found that 25% of patients had a β-hCG level less than 1000 mIU/mL, yet a pelvic ultrasound suspicious for ectopic pregnancy [12]. Our case illustrates the ongoing clinical diagnostic challenges associated with ectopic pregnancy. In the correct clinical setting, it is of importance not to exclude this potentially life-threatening diagnosis with a negative urine pregnancy test. Competing InterestsThe authors declare that they have no competing interests. AcknowledgmentsThe authors thank Megan Christopher for editorial support. References
CopyrightCopyright © 2016 Johnathan Michael Sheele et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How long does it take for an ectopic pregnancy to test positive?Pregnancy test
This blood test may be repeated every few days until ultrasound testing can confirm or rule out an ectopic pregnancy — usually about five to six weeks after conception.
Can a negative pregnancy test mean ectopic pregnancy?Since 1987, eight cases of ruptured ectopic pregnancy have been reported with a negative urine pregnancy test. These patients were taken to the operating room for suspected hemoperitoneum (5). These cases and ours suggest that ectopic pregnancy should be considered even with a negative pregnancy test.
How do I know if I'm having an ectopic pregnancy?The classic and first signs of an ectopic pregnancy, regardless of where it occurs, are often abdominal or pelvic pain, and abnormal vaginal bleeding. These warning signs typically occur early — between weeks 6 and 8 of pregnancy.
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Will you get a positive pregnancy test with ectopic pregnancy
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