Table 6.1GRADE summary of findings for the risk factors, symptoms, and signs of ectopic pregnancy

Risk factor, symptom, or signNumber of studiesNumber of study participantsObserved frequency (median % [minimum – maximum])Other considerations (such as study population)Quality
Risk factors for ectopic pregnancy
Smoking3199048.1

(19–59.5)
Maximum reported in a study of proximal ectopic pregnanciesLow
No risk factors669137.2

(23.8–76.9)
Maximum reported in a study whose inclusion criterion was presentation with pain and/or bleedingModerate
Prior pelvic or abdominal surgery15296322.5

(9.5–100)
Maximum reported in a study of 28 caesarean scar pregnancies (maximum is otherwise 48.8%)Moderate
History of a sexually transmitted infection3249819.7

(4.9–21.3)
Maximum reported in a study whose inclusion criterion was presentation with pain and/or bleedingModerate
History of elective abortion7159418.6

(14.9–47)
NoneModerate
History of infertility10136716.9

(5.5–46.7)
Maximum reported in a study with 53% ruptured EP (maximum is otherwise 37.9%)Moderate
History of miscarriage7306916.4

(11.3–33)
NoneModerate
History of pelvic inflammatory disease18344615.5

(4–44.4)
Maximum reported in a study with 53% ruptured EP (maximum is otherwise 33%)Moderate
History of ectopic pregnancy16449810.5

(2.2–27.9)
Minimum reported in a study with 53% ruptured EP (minimum is otherwise 6%)

Maximum reported in a study of proximal ectopic pregnancies (maximum is otherwise 16.6%)
Moderate
History of IUCD use18502510.1

(2.268.4)
Minimum reported in a study with 53% ruptured EP (minimum is otherwise 4.1%)

Maximum reported in a study of 19 ovarian pregnancies (maximum is otherwise 33.3%)
Moderate
Use of the oral contraceptive pill713026.7

(0.6–64.6)
Maximum reported in a population of 65 proximal ectopic pregnancies (maximum is otherwise 15.0%)Moderate
Prior tubal surgery1133536

(3.9–18.7)
Minimum reported in a study with 74% ruptured EP (minimum is otherwise 4.8%)Moderate
Endometriosis56714.7

(3.6–32.7)
Maximum reported in a study of 49 ovarian pregnancies (maximum is otherwise 5%)Low
Symptoms reported
Abdominal or pelvic pain21335693.3

(42.9–100)
Minimum reported in a study of 49 ovarian pregnancies (minimum is otherwise 54.2%)Moderate
Amenorrhea11222873

(8.2–98)
Minimum reported in a study of 49 ovarian pregnancies (minimum is otherwise 64.3%)

Maximum reported in a study with 68% ruptured EP (maximum is otherwise 96.4%)
Moderate
Vaginal bleeding with/without clots25394264.0

(14–82)
NoneModerate
Breast tenderness366625.6

(8.9–31.7)
Minimum reported in a study with 68% ruptured EP (minimum is otherwise 25.6%)Low
Gastro-intestinal symptoms10162321.3

(2.0–48.3)
Minimum reported in a study of 49 ovarian pregnancies (minimum is otherwise 15.5%)Moderate
Dizziness/fainting/ syncope12233421.1

(4.7–84.2)
Maximum reported in a study where the denominator for this finding was n = 19 (maximum is otherwise 49%)Moderate
Shoulder tip pain781819

(5–35.1)
NoneModerate
Urinary symptoms35888.7

(5.9–23.3)
Minimum reported in a study with 68% ruptured EP (minimum is otherwise 8.7%)Low
Asymptomatic32478.3

(2.9–18.4)
Maximum reported in a study of 49 ovarian pregnanciesLow
Passage of tissue21437.6

(2.6–12.5)
Minimum reported in a study whose inclusion criterion was presentation with pain and/or bleedingModerate
Rectal pressure or pain on defecation37537

(6.7–9)
Median reported in a study with 68% ruptured EPLow
Signs identified on examination
Shock or collapse890614.7

(2–23)
Minimum reported in a study of 49 ovarian pregnancies (minimum is otherwise 10%)Moderate
Pallor19744.3

(N/A)
NoneModerate
Tachycardia or hypotension5107721

(13.6–75.6)
Minimum reported in a study with 68% ruptured EP (minimum is otherwise 15%)

Maximum reported in a study with 53% ruptured EP (maximum is otherwise 23%)
Low
Orthostatic hypotension35804.6

(3.3–17.6)
NoneModerate
Abdominal distension225936.8

(17.2–56.4)
Minimum reported in a study with 74% ruptured EPLow
Abdominal tenderness11165977.9

(7.4–91.2)
Minimum reported in a population of 27 EP initially diagnosed as PUL (minimum is otherwise 58.8%)

Maximum reported in a study with 74% ruptured EP (maximum is otherwise 91%)
Moderate
Rebound tenderness/peritone al signs9146945.1

(23.1–86)
Minimum reported in a study whose inclusion criterion was presentation with pain and/or bleedingModerate
Adnexal tenderness782182

(53.3–94.6)
Maximum reported in a study with 74% ruptured EP (maximum is otherwise 85.5%)Moderate
Cervical motion tenderness8133450.3

(33.386.5)
Minimum reported in a study whose inclusion criterion was presentation with pain and/or bleedingModerate
Pelvic tenderness117791

(N/A)
NoneModerate
Enlarged uterus695228.4 (15.4–36.7)Minimum reported in a study with 68% ruptured EP (minimum is otherwise 17.6%)Moderate
Adnexal mass985526.9

(5.1–55.7)
Minimum reported in a study whose inclusion criterion was presentation with pain and/or bleeding (minimum is otherwise 6.1%)

Maximum reported in a study with 68% ruptured EP (maximum is otherwise 49.5%)
Moderate
Palpable pelvic mass224215.7

(12.3–19)
NoneModerate

EP ectopic pregnancy, IUCD intrauterine contraceptive device, N/A not available, PUL pregnancy of unknown location,

From: 6, Diagnosis of ectopic pregnancy and miscarriage

Cover of Ectopic Pregnancy and Miscarriage
Ectopic Pregnancy and Miscarriage: Diagnosis and Initial Management in Early Pregnancy of Ectopic Pregnancy and Miscarriage.
NICE Clinical Guidelines, No. 154.
National Collaborating Centre for Women's and Children's Health (UK).
London: RCOG; 2012 Dec.
Copyright © 2012, National Collaborating Centre for Women's and Children's Health.

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