Ectopic pregnancy refers to the development of fertilized eggs outside the uterine cavity, such as the fallopian tube, uterine horn, abdominal cavity and ovaries, due to certain factors. Tubal pregnancy accounts for 95% of pregnancies, followed by abdominal pregnancy. Because of the narrow and thin walls of the site, the embryo cannot expand sufficiently to accommodate the growth and development of the egg, making it easy for the embryo to pass through the wall tube and destroy the blood vessels, resulting in hemorrhage. Although it is known that ectopic pregnancy is one of the most urgent emergencies in obstetrics and gynecology and often causes death, misdiagnosis still occurs frequently in clinical practice and disputes are constant. This is because it is often confused with other diseases with abdominal pain as the main symptom. Some patients think they have abdominal pain and bleeding caused by cold, exertion, or strenuous activity. Some easily ignored factors occur in patients such as incomplete memory of medical history, concealment of medical history, denial of marital sexual history, etc. It is due to the above reasons that doctors cannot link ectopic pregnancy at once, which brings a lot of trouble to timely diagnosis and treatment, thus it is not uncommon to have delayed treatment and waste valuable emergency time for accidents. Therefore, women of childbearing age should pay attention to the following cases: 1. Menopause: Most patients have a brief history of menopause before the onset, mostly around 6 weeks. However, some patients may mistake pathological bleeding for menstrual flow because the chorionic gonadotropin produced by the chorionic tissue is not sufficient to maintain the endometrium, or because of the early onset of the disease, and assume that there is no history of menopause. Especially for unmarried young women, some patients are reluctant to admit a history of menopause due to the presence of a chaperone and deny a history of sexual intercourse, which should raise alarm. 2, abdominal pain: is the main symptom of tubal pregnancy destruction, its incidence in 95%, often sudden lower abdominal side with tear-like or paroxysmal pain, accompanied by nausea and vomiting. It can cause radiating pain in the scapula when the diaphragm is stimulated. When fluid accumulates in the pelvic cavity, there is a feeling of swelling and defecation in the anus, and it is helpful for diagnosing ectopic pregnancy. 3. Irregular vaginal bleeding: it is mostly spotting, dark brown and small amount, not exceeding the amount of menstruation. Vaginal bleeding is caused by endometrial detachment, or tubal bleeding discharging outward through the uterine cavity. Abdominal pain accompanied by vaginal bleeding is often a sign of embryonic damage. If there is only abdominal pain but no vaginal bleeding, the embryo is still alive or the pregnancy is abdominal, which should be alerted. 4, syncope and shock: it is the result of acute intra-abdominal bleeding and severe pain. The more and faster the bleeding, the more rapid and serious the symptoms appear. It may cause dizziness, pale face, thin pulse, drop in blood pressure and cold sweat, thus leading to syncope and shock and other critical signs. The syncope caused by ectopic pregnancy can also be easily mistaken for hypoglycemia, so care should be taken to differentiate them. Even if the patient is an unmarried woman and denies having a sexual history, ectopic pregnancy should not be ruled out by the patient’s statement alone, thus delaying the diagnosis and treatment. The following tests, especially urine pregnancy test and ultrasound examination of uterine adnexa, are simple and easy to perform and can help in early diagnosis. 1. Pregnancy test: When the embryo is alive or the trophoblast is viable, the syncytial cells secrete hCG and the urine pregnancy test can be positive. Since the level of hCG in ectopic pregnancy is lower than that in normal pregnancy, the general method of hCG determination has a low positive rate, and the more sensitive beta-hCG radioimmunoassay or monoclonal antibody enzyme labeling method must be used for detection. Ultrasound diagnosis: In early tubal pregnancy, the ultrasound image shows an enlarged uterus, but the uterine cavity is empty and there is a hypoechoic area next to the uterus. This image is not an acoustic feature of tubal pregnancy and the possibility of early intrauterine pregnancy with gestational corpus luteum needs to be excluded. Ultrasonographic detection of the gestational sac and fetal heartbeat is important for the diagnosis of ectopic pregnancy. The early diagnosis of interstitial pregnancy by ultrasound is clinically important, as it can show a prominent uterine horn with localized myometrial thickening and a visible gestational sac. 3. posterior fornix aspiration Since intra-abdominal blood is most likely to accumulate in the rectal recess of the uterus, it can be aspirated via posterior fornix aspiration even if the amount of blood is small. A positive result is obtained by using an 18-gauge needle to puncture the posterior fornix of the vagina into the recto-uterine recess and drawing out dark red non-coagulated blood, indicating the presence of intra-abdominal blood accumulation. 4, endometrial pathological examination Diagnostic scraping is only applicable to patients with more vaginal bleeding, with the aim of excluding intrauterine pregnancy. The uterine discharge should be routinely sent for pathological examination. If villi are seen in the section, intrauterine pregnancy can be diagnosed; if only meconium without villi is seen, the diagnosis cannot be confirmed although ectopic pregnancy should be considered. In addition to the above examination, it should be differentiated from the following diseases, such as acute pelvic inflammatory disease in gynecology, pre-eclampsia, early pregnancy, dysmenorrhea, irregular menstruation, ruptured corpus luteum, torsion of ovarian cysts, and other diseases such as intestinal entrapment, intestinal torsion, cholelithiasis, gastroenteritis, acute appendicitis, etc. Abdominal pain of miscarriage is more moderate, mostly in the central part of the lower abdomen, paroxysmal, and generally with more vaginal bleeding. The amount of vaginal bleeding is consistent with the symptoms of systemic blood loss. There is no pressure pain or slight pressure pain in the abdomen, usually no rebound pain, and no mobile turbid sounds. Vaginal examination of the cervix is not painful, the posterior fornix is not full, the size of the uterus corresponds to the number of months of amenorrhea, and there are no parametrial masses. For those who have children or bleed more, diagnostic scraping can be performed with the instructions of the patient and family. Appendicitis is also a very common disease that we have, being an adjacent organ to the reproductive organs in the pelvis. The incidence of appendicitis is very high, so young women with right lower abdominal pain should also think of it as appendicitis. Acute appendicitis often starts as epigastric pain or full abdominal pain, gradually confined to the point of marsupial, with more prominent nausea and vomiting, more pronounced pressure pain, rebound pain and abdominal muscle tonicity. There is no amenorrhea or early pregnancy in acute appendicitis, and there is no vaginal bleeding. Abdominal pain mostly started in the upper abdomen and then was confined to the right lower abdomen, without symptoms of internal bleeding. On examination, there was muscle tension in the right lower abdomen, rebound pain with pressure at the appendix point, and no mobile turbid sounds. Pregnancy test is negative, body temperature is high, and white blood cell count is increased. The treatment of ectopic pregnancy includes conservative treatment and surgical treatment. Conservative treatment is mainly based on Chinese medicine and also includes the application of anti-cancer drugs and mifepristone; if early diagnosis can be made it is possible to use this method of treatment, which can spare some patients the pain of surgery and preserve the affected fallopian tube and increase the chance of another pregnancy, and is the treatment of choice for early ectopic pregnancy. Surgical treatment mainly includes tubal opening and suturing, tubectomy, etc. If the diagnosis is late and the rupture of the fallopian tube is difficult to repair and accompanied by hemorrhagic shock, only laparoscopic or open removal of the affected fallopian tube and blood transfusion is required. All patients with ectopic pregnancy should be hospitalized once diagnosed to facilitate observation and treatment at any time, and to facilitate timely resuscitation in case of heavy internal bleeding. “Early prevention, early detection and early treatment” are the three elements of comprehensive prevention and treatment of ectopic pregnancy, and early diagnosis is the most important.