<unk>  is a complication of<unk>  in which the embryo attaches outside the uterus. Signs and symptoms classically include abdominal pain and vaginal bleeding, but fewer than 50 percent of affected women have both of these symptoms. The pain may be described as sharp, dull, or crampy. Pain may also spread to the shoulder if bleeding into the abdomen has occurred. Severe bleeding may result in a fast heart rate, fainting, or shock. With very rare exceptions the fetus is unable to survive. Risk factors for<unk>  include pelvic inflammatory disease, often due to chlamydia infection; tobacco smoking; prior tubal surgery; a history of infertility; and the use of assisted reproductive technology. Those who have previously had an<unk>  are at much higher risk of having another one. Most<unk> es (90%) occur in the fallopian tube, which are known as tubal<unk> es, but implantation can also occur on the cervix, ovaries, cesarean scar, or within the abdomen. Detection of<unk>  is typically by blood tests for human chorionic gonadotropin (hCG) and ultrasound. This may require testing on more than one occasion. Ultrasound works best when performed from within the vagina. Other causes of similar symptoms include: miscarriage, ovarian torsion, and acute appendicitis. Prevention is by decreasing risk factors such as chlamydia infections through screening and treatment. While some<unk> es will resolve without treatment, this approach has not been well studied as of 2014. The use of the medication methotrexate works as well as surgery in some cases. Specifically it works well when the beta-HCG is low and the size of the<unk>  is small. Surgery such as a salpingectomy is still typically recommended if the tube has ruptured, there is a fetal heartbeat, or the person's vital signs are unstable. The surgery may be laparoscopic or through a larger incision, known as a laparotomy. Maternal morbidity and mortality are reduced with treatment. The rate of<unk>  is about 1% and 2% that of live births in developed countries, though it may be as high as 4% among those using assisted reproductive technology. It is the most common cause of death among women during the first trimester at approximately 6-13% of the total. In the developed world outcomes have improved while in the developing world they often remain poor. The risk of death among those in the developed world is between 0.1 and 0.3 percent while in the developing world it is between one and three percent. The first known description of an<unk>  is by Al-Zahrawi in the 11th century. The word<unk> " means "out of place".
Ectopic pregnancy
Miscarriage
Ovarian torsion
Appendicitis
Tubo-ovarian abscess
Ovarian cyst
Ovarian pregnancy
Dysmenorrhea