Which feature is most indicative of an ectopic pregnancy?

• A. Positive pregnancy test with abdominal/pelvic pain and adnexal tenderness.
• B. Regular menses with no pain.
• C. Ongoing vaginal bleeding with cycles.
• D. Pain only with ovulation.

Answer: (A)

An ectopic pregnancy is pregnancy that implants outside the uterine cavity, most often in the fallopian tube. The clearest clinical clue is a positive pregnancy test accompanied by abdominal or pelvic pain and adnexal tenderness, which signals that the pregnancy may be located outside the uterus and requires urgent evaluation. This combination distinguishes it from nonpregnant states or typical menstrual/ovulation-related pain: regular menses with no pain suggests no ongoing pregnancy; ongoing vaginal bleeding with cycles points to abnormal uterine bleeding rather than a localized ectopic gestation; pain only with ovulation (mittelschmerz) is unrelated to pregnancy location.