I don't know how many ectopics I have seen here, but any women of child bearing age is at risk, and it has to come into the differential, whether their history fits or not. A typical history is a women who hasn't had a kid despite being married for a number of years, has missed her period for 2 months, has some lower abdominal pain and bleeding. If everyone fit into this history, it would be easy to find them. Our patients usually don't fit that pattern so we have to keep the dx of ectopic pregnancy in the differential no matter what the history is. Recently, I had a women who reported normal periods, has a 4 yo child, and denied being with anyone recently. She was anemic with a hgb of 5 with a belly full of fluid and a positive pregnancy test - despite her history, she was had a ruptured ectopic.
The other day was a record day though. I diagnosed 3 ectopic pregnancies in one day with the help of our ultrasound machine. Our ultrasound machine is one of the best purchases we made (thanks to all of those who contributed and made the purchase of the machine possible.) I didn't know a thing about doing ultrasounds prior to coming here, but now after doing over 1000, I feel like I have a pretty good idea of what I am looking at. Each of the 3 ectopics was a little different. One was ruptured (her belly was full of blood), one was unruptured (baby still inside the tube and no fluid in her abdomen), and one was a heterotopic (a baby inside the uterus and one outside the uterus which had ruptured). Unfortunately our surgeon, Jim, wasn't here, so they were all transferred to Hagen for their surgeries, a busy day for Hagen.