Incidence, diagnosis and management of ectopic pregnancies: A review

Abstract

Background: Ectopic pregnancy; the conceptus implanting outside the uterine cavity, arises in 1.3–2.4% of all pregnancies which put the lives of many young women in peril. It causes major maternal morbidity and mortality and its incidence is increasing worldwide. Though the set medical practices to address the grave situation are improved, it still remains worrying to note in third world countries. Methods: We review the incidence, causes, diagnosis, and management of ectopic pregnancy. The evidence presented is from a combination of selected published papers identified from Medline and a reflection of clinical practice in our unit. Results: Diagnosis involves a combination of clinical symptoms, serology, and ultrasound. Medical management with methotrexate is an effective option in most clinically stable patients. Patients, who have failed medical management or presented with ruptured ectopic pregnancy are most frequently managed with excision by laparoscopy or, less commonly, laparotomy. Following tubal ectopic pregnancy, the rate of subsequent intrauterine pregnancy is high and independent of treatment modality. Conclusion: This review describes the incidence, risk factors, diagnosis, and management of tubal and non-tubal ectopic pregnancies, and reviews the existing data regarding recurrence and future fertility.