From the Research
Introduction to Ectopic Pregnancy
Ectopic pregnancy is a condition where a fertilized ovum implants outside of the uterine cavity, often in the fallopian tube. This condition can be life-threatening and requires prompt diagnosis and treatment.
Risk Factors for Ectopic Pregnancy
The risk factors for ectopic pregnancy include:
- History of pelvic inflammatory disease
- Cigarette smoking
- Fallopian tube surgery
- Previous ectopic pregnancy
- Infertility
- Endometriosis
- Chlamydia trachomatis infection
- Induced conception cycle 1
Prevention Methods for Ectopic Pregnancy
While there are no guaranteed prevention methods for ectopic pregnancy, reducing the risk factors can help minimize the likelihood of occurrence. This includes:
- Avoiding cigarette smoking
- Practicing safe sex to reduce the risk of pelvic inflammatory disease
- Avoiding unnecessary fallopian tube surgery
- Seeking medical attention for any symptoms of pelvic inflammatory disease or other risk factors
Signs and Symptoms of Ectopic Pregnancy
The signs and symptoms of ectopic pregnancy include:
- Vaginal bleeding
- Lower abdominal pain
- Pelvic pain
- Shoulder pain
- Dizziness or fainting
- Nausea and vomiting
- The classic triad of symptoms (abdominal pain, vaginal bleeding, and amenorrhea) is only present in a small percentage of patients 2
Diagnosis of Ectopic Pregnancy
The diagnosis of ectopic pregnancy can be made using:
- Ultrasound visualization of a yolk sac and/or embryo in the adnexa
- Serial beta human chorionic gonadotropin levels
- Serial ultrasonography
- Uterine aspiration
- Endometrial sampling, such as dilation and curettage 3
Treatment Options for Ectopic Pregnancy
The treatment options for ectopic pregnancy include:
Medical Treatment
- Intramuscular methotrexate, which can be administered in a single dose or multiple doses
- The dosage of methotrexate is typically 50 mg/m², administered intramuscularly
- The treatment is usually effective, but may require additional doses or surgical intervention if the serum hCG levels do not decline adequately 4, 5
Surgical Treatment
- Laparoscopic salpingostomy or salpingectomy
- Open surgical procedure
- The choice of surgical treatment depends on the patient's condition and the severity of the ectopic pregnancy
Expectant Management
- This approach is only suitable for patients with a low risk of ectopic pregnancy rupture and stable vital signs
- The patient is closely monitored with serial beta human chorionic gonadotropin levels and ultrasonography
Differentials and Caveats
- The treatment choice should be based on short-term and long-term outcome measures, including primary treatment success, reinterventions, tubal patency, and future fertility 4
- Patients with peritoneal signs or hemodynamic instability require immediate surgical intervention
- Patients with a high initial beta human chorionic gonadotropin level or fetal cardiac activity detected outside of the uterus on ultrasonography require prompt treatment
- The treatment approach may vary depending on the patient's individual circumstances and medical history 5, 3