What is an ectopic pregnancy?

From the Guidelines

An ectopic pregnancy occurs when a fertilized egg implants and grows outside the main cavity of the uterus, most commonly in a fallopian tube, and is a life-threatening condition that requires immediate medical attention. This condition is dangerous because the growing embryo cannot survive outside the uterus and the growing tissue may cause life-threatening bleeding if left untreated. Symptoms typically include abdominal pain, vaginal bleeding, and missed menstrual periods. Treatment depends on how far the pregnancy has progressed and may include medication (methotrexate) to stop cell growth and dissolve existing cells, or surgery (laparoscopy or laparotomy) to remove the ectopic tissue and sometimes the affected fallopian tube.

Key Points

• Ectopic pregnancy is a serious condition that can cause severe internal bleeding, shock, and even death if left untreated 1.
• The condition occurs when a fertilized egg implants and grows outside the main cavity of the uterus, most commonly in a fallopian tube 1.
• Risk factors include previous ectopic pregnancies, pelvic inflammatory disease, previous tubal surgery, and certain fertility treatments 1.
• Symptoms typically include abdominal pain, vaginal bleeding, and missed menstrual periods 1.
• Treatment depends on how far the pregnancy has progressed and may include medication (methotrexate) or surgery (laparoscopy or laparotomy) 1.
• Immediate medical attention is essential if an ectopic pregnancy is suspected, as rupture can cause severe internal bleeding, shock, and even death 1.

Diagnosis and Treatment

• Ultrasound is the primary imaging modality used to diagnose ectopic pregnancy, and can help identify the location of the pregnancy and guide treatment decisions 1.
• The use of methotrexate or surgical intervention should be based on positive findings, rather than solely on the absence of an intrauterine pregnancy 1.
• The diagnosis of ectopic pregnancy should be made with caution, and should be based on a combination of clinical, laboratory, and imaging findings 1.

From the Research

Definition of Ectopic Pregnancy

• Ectopic pregnancy occurs when a fertilized ovum implants outside of the uterine cavity 2, 3, 4, 5, 6.
• The most common site of ectopic pregnancy is the fallopian tube 4, 5.

Risk Factors and Prevalence

• Risk factors for ectopic pregnancy include a history of pelvic inflammatory disease, cigarette smoking, fallopian tube surgery, previous ectopic pregnancy, and infertility 2.
• The estimated prevalence of ectopic pregnancy is 1% to 2% in the United States 2.
• Ruptured ectopic pregnancy accounts for 2.7% of pregnancy-related deaths 2.

Diagnosis and Management

• The definitive diagnosis of ectopic pregnancy can be made with ultrasound visualization of a yolk sac and/or embryo in the adnexa 2.
• Patient symptoms combined with serial ultrasonography and trends in beta human chorionic gonadotropin levels are used to make the diagnosis 2.
• Treatment of diagnosed ectopic pregnancy includes medical management with intramuscular methotrexate, surgical management via salpingostomy or salpingectomy, and, in rare cases, expectant management 2, 6.
• Surgery is the primary treatment for interstitial ectopic pregnancy, but pharmacological management with methotrexate can be used in asymptomatic patients 6.

Rare Cases and Complications

• Rare cases of ectopic pregnancy can occur in atypical locations, such as the round ligament 3.
• These cases can pose significant risks and lead to life-threatening complications 3.
• Interstitial ectopic pregnancy, where the gestational sac is implanted into the interstitial part of the Fallopian tube, surrounded by a layer of the myometrium, is a rare and challenging condition to diagnose and manage 6.