Will ectopic pregnancy cause bleeding after 30 days?

When you first get pregnant, pregnant mothers actually don’t feel much. Especially for women with irregular menstruation, they cannot detect pregnancy in time. For special cases like ectopic pregnancy, we are even less aware of the specific body reactions. So, will bleeding occur after 30 days of ectopic pregnancy? In fact, it is not necessarily the case. Although ectopic pregnancy can cause vaginal bleeding, it is impossible to accurately know when the symptoms will appear.

Clinical manifestations

1. Menopause

Except for pregnancy in the fallopian tube interstitial region, which lasts for a longer period of time, most cases last for 6 to 8 weeks. 20% to 30% of patients have no obvious history of amenorrhea, or their menstruation is only delayed by two or three days.

2. Vaginal bleeding

After the death of the embryo, there is often irregular vaginal bleeding, which is dark red in color and small in amount, generally not exceeding the amount of menstruation. A small number of patients have heavy vaginal bleeding, similar to menstruation, and may be accompanied by the discharge of decidual fragments.

3. Syncope and shock

Due to acute intra-abdominal bleeding and severe abdominal pain, mild cases may experience fainting, while severe cases may suffer from hemorrhagic shock. The more and faster the bleeding, the quicker and more severe the symptoms appear, but they are not proportional to the amount of vaginal bleeding.

Differential Diagnosis

1. Threatened abortion in early pregnancy

The abdominal pain of threatened abortion is generally mild, the size of the uterus is basically consistent with the month of pregnancy, the amount of vaginal bleeding is small, and there is no sign of internal bleeding. B-ultrasound can be used for identification.

2. Ovarian corpus luteum rupture and bleeding

Corpus luteum rupture often occurs during the luteal phase, or menstrual period. However, it is sometimes difficult to differentiate from ectopic pregnancy, especially in patients with no obvious history of amenorrhea and irregular vaginal bleeding. β-HCG is often required for diagnosis.

3. Ovarian cyst pedicle torsion

The patient has normal menstruation and no signs of internal bleeding. Generally, there is a history of adnexal mass and obvious tenderness at the cyst pedicle. The diagnosis can be confirmed by gynecological examination combined with B-ultrasound.

4. Rupture and bleeding of ovarian chocolate cyst

The patient has a history of endometriosis, which often occurs before or during menstruation. The pain is quite severe and may be accompanied by obvious anal swelling. The diagnosis can be confirmed by extracting chocolate-like fluid through puncture of the posterior vaginal fornix. If the rupture injures blood vessels, signs of internal bleeding may appear.

5. Acute pelvic inflammatory disease

In acute or subacute inflammation, there is generally no history of amenorrhea, abdominal pain is often accompanied by fever, blood count and erythrocyte sedimentation rate are often elevated, B-ultrasound can detect adnexal masses or pelvic effusion, and urine HCG can assist in diagnosis. Especially after anti-inflammatory treatment, inflammatory manifestations such as abdominal pain and fever can gradually alleviate or disappear.

6. Surgical conditions

Acute appendicitis often presents with obvious migratory right lower abdominal pain, often accompanied by fever, nausea, vomiting, and increased blood count. Ureteral stones cause colic pain on one side of the lower abdomen, accompanied by ipsilateral flank pain and hematuria. The diagnosis can be confirmed by combining ultrasound and X-ray examination.