Only 60% of women with extopic have a history of a missed period
Classic presentation is irregular menstruation, bleeding, abdomina/pelvic pain, tender adnexal mass. ( of course not often found)
Risk factors: 1) Abnormal falopian rubes secondary to prior infection, developmental defect or surgery, 2) normal falopian tubes but with IUD, on induction therapy, delayed tubal transport or 3) history of prior ectopic
If the ectopic is in an expandable region like cornual or peritoneal, presentation is later than with tubular location, as late as 2nd or 3rd trimester
There can be an intrauterine fluid collection without normal fetal structures - this is a pseudogestational sac. It is usually abnormal, elongated because it conforms to the uterine canal
Even with a true ectopic - 10-20% of exams are normal.
Except in the extreemly rare case of heterotopic pregnancy, if an IUP is found, there is no ectopic pregnancy
Conversely if beta is positive but no IUP is found, ANY strange finding is suspicious
1) can see an actual embryo with heart motion (15% of TA and 20-30% of TV exams)
2) tubal ring or adnexal mass has a 95% predictive value
3) intraperitoneal fluid, especially with internal echous, the larger the worses and more predictive
Differential includes endometrioma, PID with or without abscess, hydrosalpinx, pyosalpinx, dermoids. None of these have a positive beta of course.