Diagnosis and management of ectopic pregnancy

Abstract

Ectopic pregnancy is the abnormal location of a pregnancy, outside of the uterus. The most common location of an ectopic pregnancy is the fallopian tube although ectopic pregnancies may also be found in the cervix, interstitial segment of the fallopian tube, ovary, uterine scar from previous cesarean section, or abdominal cavity. The greatest risk to maternal morbidity and mortality associated with ectopic pregnancy is tubal rupture, leading to hemodynamic instability and rapid maternal decompensation. Therefore, early detection and treatment can lead to improved maternal outcomes. Diagnosis of ectopic pregnancy can generally be made using a combination of serial beta HCG monitoring and transvaginal ultrasound. First-line treatment in a stable patient is usually methotrexate. Methotrexate may be administered via a fixed multidose, single-dose, or two-dose regimen in combination with close beta HCG monitoring. For women who fail medical management, in whom medical management is contraindicated, or for whom tubal rupture is suspected, laparoscopic surgery is the treatment of choice. Surgical management may be accomplished by either salpingostomy or salpingectomy, depending on patient characteristics.