Actualización del enfrentamiento y manejo de localizaciones poco frecuentes del embarazo ectópico

Abstract

ABSTRACT Introduction and Objectives: Non tubal Ectopic Pregnancy is a rare condition, associated with high maternal morbidity and mortality. There is little information that completely covers the different types of non-tubal ectopic pregnancy. The objective of this publication is to describe an update on the assessment and management of the different types of ectopic pregnancy. Methods: By using the database Epistemonikos, Scielo, Cochrane and Pubmed, we reviewed the existing literature on tubal, cornual/interstitial, abdominal, ovarian, cervical and caesarean section scar EE. Results: To make the diagnosis, it is necessary to consider the clinical feature and history. β-hCG levels should be measured and supplemented by transvaginal ultrasound. However, the diagnosis is often made with laparoscopy. In caesarean section scar, ovarian, abdominal and interstitial ectopic pregnancy, laparoscopic surgical management is of choice. Methotrexate is not recommended as first line treatment. In cervical ectopic pregnancy, methotrexate is the first choice. In hemodynamic instability or suspected broken ectopic pregnancy, an exploratory laparotomy is necessary. In heterotopic pregnancy, methotrexate has an absolute contraindication, with laparoscopic salpingectomy being the recommended first line approach. Conclusions: This update describes the incidence, risk factors, diagnosis, and management of the different types of non-tubal ectopic pregnancy. It is important to emphasize the low rate of clinical suspicion of this pathology. Early diagnosis and treatment are essential to reduce complications associated with this pathology.