What symptom would most strongly suggest a ruptured ectopic pregnancy?

Severe pelvic pain is a hallmark symptom of a ruptured ectopic pregnancy. This intense pain typically occurs on the side where the ectopic tissue is located and may be accompanied by referred shoulder pain due to diaphragmatic irritation from internal bleeding. The severity of the pain is often indicative of the extent of the rupture and the associated complications, such as intraperitoneal bleeding.

While vaginal bleeding, regular contractions, and nausea/vomiting can be associated with ectopic pregnancies or other complications in early pregnancy, they do not specifically indicate a rupture as strongly as severe pelvic pain does. Vaginal bleeding may occur in various pregnancy-related conditions, and regular contractions are more characteristic of labor than a ruptured ectopic pregnancy. Nausea and vomiting could be common in many pregnancies and are not unique to ruptured ectopic cases. Therefore, the presence of severe pelvic pain is the most concerning symptom signaling potential rupture and warrants immediate medical evaluation.