What are the key clinical features and risk factors to consider when diagnosing ectopic pregnancy in a primary care setting?

Key clinical features to consider when diagnosing ectopic pregnancy in primary care include:

• Common symptoms: abdominal or pelvic pain, amenorrhoea or missed period, and vaginal bleeding with or without clots.
• Other possible symptoms: breast tenderness, gastrointestinal symptoms, dizziness, fainting or syncope, shoulder tip pain, urinary symptoms, passage of tissue, rectal pressure or pain on defecation.
• Common signs on examination: pelvic tenderness, adnexal tenderness, and abdominal tenderness.
• Other signs: cervical motion tenderness, rebound tenderness or peritoneal signs, pallor, abdominal distension, enlarged uterus, tachycardia (heart rate >100 bpm), hypotension (BP <100/60 mmHg), shock or collapse, and orthostatic hypotension.

Risk factors to consider include:

• Previous ectopic pregnancy (although about one-third of women with ectopic pregnancy have no known risk factors, so absence of risk factors does not exclude diagnosis).
• Other risk factors are not explicitly detailed in the provided context but should be considered in clinical assessment.

Additional considerations:

• Women of reproductive age presenting with non-specific symptoms should be offered a pregnancy test as ectopic pregnancy symptoms can mimic other conditions such as gastrointestinal or urinary tract infections.
• Women who are haemodynamically unstable or have significant pain or bleeding should be referred immediately to Accident and Emergency.
• Women with a positive pregnancy test and abdominal, pelvic, or cervical motion tenderness should be referred urgently to an early pregnancy assessment service or out-of-hours gynaecology service for further assessment.

These clinical features and risk factors guide the need for urgent referral and further specialist assessment including ultrasound and serum hCG measurement to confirm diagnosis and management planning.