Ectopic Pregnancy and Early Pregnancy Loss

First-trimester bleeding and pelvic pain can signal a self-limited early pregnancy loss, but they can also be the first warning of an ectopic pregnancy. The nurse’s first task is not to label the bleeding. It is to determine whether the patient is perfusing adequately and whether the pregnancy has been located. An ectopic pregnancy is implanted outside the uterine cavity, most often in a fallopian tube. As trophoblastic tissue grows, the tube may stretch, bleed, and rupture. A patient can therefore have little vaginal bleeding while losing a dangerous amount of blood internally. Early pregnancy loss, by contrast, is a nonviable intrauterine pregnancy; it may cause cramping, vaginal bleeding, and passage of tissue, but it does not explain every painful or unstable presentation. The distinction is made with the patient’s clinical condition, transvaginal ultrasonography, and quantitative serum hCG interpreted together. A positive pregnancy test with pain or bleeding remains an ectopic concern until an intrauterine pregnancy is confirmed and the overall clinical picture fits.