Incidence, diagnosis and management of tubal and nontubal ectopic pregnancies: a review.

Danielle M Panelli,Catherine H Phillips,Paula C Brady

doi:10.1186/s40738-015-0008-z

Danielle M Panelli, Catherine H Phillips + Show 1 more

Open Access

https://doi.org/10.1186/s40738-015-0008-z

Copy DOI

Abstract

BackgroundEctopic pregnancy is a potentially life-threatening condition occurring in 1-2 % of all pregnancies. The most common ectopic implantation site is the fallopian tube, though 10 % of ectopic pregnancies implant in the cervix, ovary, myometrium, interstitial portion of the fallopian tube, abdominal cavity or within a cesarean section scar.FindingsDiagnosis involves a combination of clinical symptoms, serology, and ultrasound. Medical management is a safe and effective option in most clinically stable patients. Patients who have failed medical management, are ineligible, or present with ruptured ectopic pregnancy or heterotopic pregnancy are most often managed with excision by laparoscopy or, less commonly, laparotomy. Management of nontubal ectopic pregnancies may involve medical or surgical treatment, or a combination, as dictated by ectopic pregnancy location and the patient's clinical stability. Following tubal ectopic pregnancy, the rate of subsequent intrauterine pregnancy is high and independent of treatment modality.ConclusionThis review describes the incidence, risk factors, diagnosis, and management of tubal and non-tubal ectopic and heterotopic pregnancies, and reviews the existing data regarding recurrence and future fertility.

Highlights

Ectopic pregnancy is a potentially life-threatening condition occurring in 1-2 % of all pregnancies
The most common ectopic pregnancy (EP) location is in the fallopian tube, predominantly the ampullary region of the fallopian tube
‘Cornual’ pregnancies are those implanted in a horn of an anomalous uterus; these do not

Summary

Introduction

Ectopic pregnancy is a potentially life-threatening condition occurring in 1-2 % of all pregnancies. In a meta-analysis including 503 women with EPs treated with single dose MTX, successful treatment, defined as avoidance of surgery, for initial β-hCG levels between 1000 and 1999 mIU/mL was 94.4 %, compared with just 81.8 % in patients with starting β-hCG levels of 10,000 to 150,000 mIU/mL [134]. A recent randomized controlled trial of 120 women receiving single or multiple dose MTX reported no difference in success rates, though the time until β-hCG normalization was longer following the single dose regimen (22.3 vs 18.3 days, respectively) [140].

Results

Conclusion