Ectopic Pregnancy vs Spontaneous Abortion
Ectopic Pregnancy and Spontaneous Abortion are easy to mix up on the boards. Here's a side-by-side comparison — presentation, workup, imaging, and first-line treatment — drawn from our full outlines.
Ectopic Pregnancy vs Spontaneous Abortion at a glance
- Ectopic Pregnancy: Implantation outside the uterine cavity — most commonly tubal; life-threatening hemorrhage if ruptured.
- Spontaneous Abortion: Pregnancy loss before 20 weeks — most commonly first-trimester aneuploidy; expectant, medical, or surgical management.
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Side-by-side comparison
| Feature | Ectopic Pregnancy | Spontaneous Abortion |
|---|---|---|
| At a glance | Implantation outside the uterine cavity — most commonly tubal; life-threatening hemorrhage if ruptured. | Pregnancy loss before 20 weeks — most commonly first-trimester aneuploidy; expectant, medical, or surgical management. |
| Classic presentation | Reproductive-age woman with amenorrhea, unilateral pelvic pain, vaginal bleeding, positive pregnancy test, and no intrauterine pregnancy on TVUS.; Amenorrhea (missed period); Unilateral pelvic or abdominal pain; Vaginal bleeding (often light); Shoulder tip pain (referred from diaphragmatic blood); Dizziness, syncope (hemorrhage); Some… | Vaginal bleeding (light spotting to heavy hemorrhage); Crampy lower abdominal/pelvic pain; Passage of tissue (clots, products of conception); Loss of pregnancy symptoms (decreased breast tenderness, nausea); Missed abortion may be asymptomatic — identified at routine ultrasound; Speculum: open or closed cervix, blood, ± visible products… |
| Workup / key labs | Pregnancy of unknown location: positive β-hCG without IUP or extrauterine findings on TVUS — requires serial β-hCG and possibly D&C to distinguish failed IUP from ectopic. Ectopic confirmed by visualization of extrauterine pregnancy or by absence of chorionic villi on D&C with persistent or rising β-hCG.; Quantitative serum β-hCG —… | Quantitative serum β-hCG (declining or plateauing suggests nonviable); CBC, blood type and Rh, antibody screen; Coagulation studies if heavy bleeding or suspected DIC (septic abortion); Recurrent pregnancy loss workup: TSH, prolactin, A1c, antiphospholipid antibodies (lupus anticoagulant, anticardiolipin, anti-β2GP1), parental… |
| Imaging | Transvaginal ultrasound — primary imaging; look for intrauterine gestational sac (with yolk sac or embryo), adnexal mass, free fluid in pelvis; Doppler may show 'ring of fire' (vascular ectopic); Definitive: extrauterine gestational sac with yolk sac/embryo or extrauterine cardiac activity; Pseudogestational sac (collapsed fluid in… | Transvaginal ultrasound — gestational sac visible at β-hCG ~1500-2000, yolk sac ~5-6 weeks, fetal pole with cardiac activity ~6 weeks; Diagnostic criteria for early pregnancy loss (SRU 2013):; • Crown-rump length ≥7 mm without cardiac activity, OR; • Mean sac diameter ≥25 mm without embryo, OR; • Absence of embryo with heartbeat ≥2… |
| First-line treatment | Hemodynamically unstable, ruptured, or large ectopic: emergent surgery (laparoscopic salpingectomy preferred over salpingostomy); Hemodynamically stable, candidate criteria met: methotrexate (intramuscular); Anti-D immunoglobulin (RhoGAM) for Rh-negative women; All require post-treatment β-hCG monitoring until <5 mIU/mL | Counseling and shared decision-making among three options:; Expectant management (1-4 weeks for spontaneous completion) — ~80% effective for incomplete; lower (~30-50%) for missed; Medical management — misoprostol 800 mcg vaginally (with optional repeat dose); add mifepristone 200 mg PO 24 h before misoprostol for superior efficacy… |
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