European Journal of Molecular & Clinical Medicine

Ectopic pregnancy occurs when a fertilized ovum implants outside of the uterine
cavity. In the United States, the estimated prevalence of ectopic pregnancy is 1% to
2%, and ruptured ectopic pregnancy accounts for 2.7% of pregnancy-related
deaths. Risk factors include a history of pelvic inflammatory disease, cigarette
smoking, fallopian tube surgery, previous ectopic pregnancy, and infertility. Ectopic
pregnancy should be considered in any patient presenting early in pregnancy with
vaginal bleeding or lower abdominal pain in whom intrauterine pregnancy has not
yet been established. The definitive diagnosis of ectopic pregnancy can be made
with ultrasound visualization of a yolk sac and/or embryo in the adnexa. However,
most ectopic pregnancies do not reach this stage. More often, patient symptoms
combined with serial ultrasonography and trends in beta human chorionic
gonadotropin levels are used to make the diagnosis. Pregnancy of unknown
location refers to a transient state in which a pregnancy test is positive, but
ultrasonography shows neither intrauterine nor ectopic pregnancy. Serial beta
human chorionic gonadotropin levels, serial ultrasonography, and, at times, uterine
aspiration can be used to arrive at a definitive diagnosis. Treatment of diagnosed
ectopic pregnancy includes medical management with intramuscular methotrexate,
surgical management via salpingostomy or salpingectomy, and, in rare cases,
expectant management. A patient with diagnosed ectopic pregnancy should be
immediately transferred for surgery if she has peritoneal signs or hemodynamic
instability, if the initial beta human chorionic gonadotropin level is high, if fetal
cardiac activity is detected outside of the uterus on ultrasonography, or if there is a
contraindication to medical management