What are the characteristics of abdominal pain in ectopic pregnancy?

Abdominal pain in ectopic pregnancy usually manifests as severe tearing pain in the lower abdomen on one side, which may be accompanied by vaginal bleeding, shoulder radiating pain and shock symptoms. Ectopic pregnancy refers to the implantation of a fertilized egg outside the uterine cavity, usually in the fallopian tube, and requires emergency medical treatment.

1. Severe pain in unilateral lower abdomen

Abdominal pain in ectopic pregnancy is mostly concentrated in the lower abdomen on the side of the fallopian tube. It initially appears as dull or distending pain, but as the embryo grows, it can develop into persistent tearing pain. Pain is related to fallopian tube dilation and rupture, and may be accompanied by peritoneal irritation signs such as tenderness and rebound tenderness. Patients often cannot walk upright due to pain and need immediate medical attention to rule out the risk of fallopian tube rupture.

2. Irregular vaginal bleeding

About 70% of patients with ectopic pregnancy will experience a small amount of dark red vaginal bleeding, and the blood may be mixed with decidua tissue. The amount of bleeding is often not directly proportional to the degree of abdominal pain, and can easily be mistaken for abnormal menstruation. This type of bleeding results from the shedding of the lining of the uterus caused by falling hormone levels, but is different from the regularity and volume of normal menstruation.

3. Radiating pain in shoulder

When an ectopic pregnancy ruptures and causes intra-abdominal bleeding, the accumulation of blood stimulates the phrenic nerve and can cause referred pain in the scapular area. This is a critical sign, indicating that the amount of abdominal bleeding may exceed 500 ml. Patients often experience blood loss symptoms such as pale complexion and rapid pulse at the same time, and require emergency surgery to stop bleeding.

4. Shock symptoms

When the fallopian tube ruptures and bleeds massively, the patient will experience hemorrhagic shock symptoms such as decreased blood pressure, clammy limbs, and confusion. An elevated shock index indicates that the bleeding volume exceeds 20% of the systemic blood volume, and immediate blood transfusion and laparoscopic or open surgery are required. Common surgical procedures are salpingectomy or conservative salpingotomy.

5. Accompanied by gastrointestinal symptoms

About 40% of patients suffer from digestive system symptoms such as nausea, vomiting, and anal distension. It is caused by pelvic blood irritating the rectum and can easily be confused with gastroenteritis. Some patients will experience frequent urination and urgency, but there is no evidence of infection in the urine test. This is caused by the influence of pregnancy hormones and hematoma compressing the bladder.

When an ectopic pregnancy is suspected, bed rest should be absolute and actions that increase abdominal pressure should be avoided. Choose easy-to-digest liquid foods in your diet, and monitor changes in blood pressure and heart rate. All suspected cases require emergency ultrasound examination, and dynamic monitoring of blood HCG is crucial. During the postoperative recovery period, iron supplements are required to correct anemia, and contraception is strictly required within 6 months. The patency of the fallopian tubes should be reviewed regularly, and early ultrasound should be used to confirm the position of the embryo for subsequent pregnancies.