<P> Prevention is by decreasing risk factors such as chlamydia infections through screening and treatment . While some ectopic pregnancies 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 ectopic is small . Surgery 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 . Outcomes are generally good with treatment . </P> <P> The rate of ectopic pregnancy 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 10% 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 ectopic pregnancy is by Al - Zahrawi in the 11th century . The word "ectopic" means "out of place". </P> <P> Up to 10% of women with ectopic pregnancy have no symptoms, and one third have no medical signs . In many cases the symptoms have low specificity, and can be similar to those of other genitourinary and gastrointestinal disorders, such as appendicitis, salpingitis, rupture of a corpus luteum cyst, miscarriage, ovarian torsion or urinary tract infection . Clinical presentation of ectopic pregnancy occurs at a mean of 7.2 weeks after the last normal menstrual period, with a range of 4 to 8 weeks . Later presentations are more common in communities deprived of modern diagnostic ability . </P> <P> Signs and symptoms of ectopic pregnancy include increased hCG, vaginal bleeding (in varying amounts), sudden lower abdominal pain, pelvic pain, a tender cervix, an adnexal mass, or adnexal tenderness . In the absence of ultrasound or hCG assessment, heavy vaginal bleeding may lead to a misdiagnosis of miscarriage . Nausea, vomiting and diarrhea are more rare symptoms of ectopic pregnancy . </P>

When do the clinical manifestations of an ectopic pregnancy typically appear