Diagnosis and Management of Ectopic Pregnancy

Abstract

Ectopic pregnancy remains to be an important cause of maternal morbidity and mortality worldwide, although the incidence has remained unchanged especially in developed countries over the last decade. Several factors are responsible for this, including misdiagnosis and failure to institute timely appropriate treatment aimed at preserving fertility and minimizing the associated morbidity. Recent advances in imaging and biomonitoring have reduced the number of women presenting with ruptured ectopic pregnancy. Any attempt to reduce the consequences of ectopic pregnancies must, therefore, focus on improving the diagnosis of the unruptured type and evidenced-based treatment, which is cost effective. In this review, the authors discuss the diagnosis and treatment of this complication in the light of the recent evidence highlighting how improvements can be made to reduce the consequences.

Clinicosociodemographic profile of ruptured ectopic pregnancies at a tertiary care centre

“…30 A ruptured ectopic pregnancy may manifest itself with abdominal pain, rebound tenderness, and hemorrhagic/hypovolemic shock. 31 In our study we found 56.14% of cases of ruptured ectopic pregnancy were admitted with shock and 85.17% of cases were found to be with hemoperitoneum of more than 500ml of blood.…”

“…4 As far as diagnosis of ruptured ectopics is concerned no particular investigation including serum or urinary beta human chorionic gonadotropin and transvaginal ultrasonography are conclusive and sometimes a surgical approach is required for the differential diagnosis. 5,6 In addition to high risk for mortality, rupture of an ectopic pregnancy could affect future fertility of a woman.…”

Ectopic Mural Pregnancy

“…Интерстициальная беременность (interstitial ectopic pregnancy) (IEP) Частота патологии в структуре ВБ от 2 до 11% [2,3,4,5,12,[23][24][25]. Глубина публикаций -с 1928 года, отмечен рост числа публикаций с 1998 года (18 за год).…”

“…При относительно небольшой частоте встречаемости (от 5,0% до 8,3% в структу-ре ВБ) эта патология отличается высоким риском массивных кровотечений, вплоть до летального исхода [2][3][4][5]. Рост числа случаев внетубарных ВБ в последние десятилетия связан как с изменением структуры факторов риска, так и с совершенство-ванием методов ранней диагностики, что требует пересмотра диагностических и лечебных протоко-лов [6].…”

Systematic review and meta‐analysis of single‐dose and non‐single‐dose methotrexate protocols in the treatment of ectopic pregnancy

“…The incidence of ectopic pregnancy is approximately 1–2% of all pregnancies, and ectopic pregnancy accounts for 3–4% of pregnancy‐related deaths . Various noninvasive methods (transvaginal sonography; measurement of β‐human chorionic gonadotropin [β‐hCG] and serum progesterone levels) are used to diagnose ectopic pregnancy …”