Materiały źródłowe

• #1 Ectopic Pregnancy: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2020/0515/p599.html

  Ectopic pregnancy occurs when a fertilized ovum implants outside of the uterine cavity. […] 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. […] Serial beta human chorionic gonadotropin levels, serial ultrasonography, and, at times, uterine aspiration can be used to arrive at a definitive diagnosis. […] The physical examination can reveal signs of hemodynamic instability (e.g., hypotension, tachycardia) in women with ruptured ectopic pregnancy and hemoperitoneum.

• #2 Ectopic Pregnancy: Causes, Symptoms & Treatments

  https://my.clevelandclinic.org/health/diseases/9687-ectopic-pregnancy

  An ectopic pregnancy is a pregnancy that happens outside of your uterus. This occurs when a fertilized egg implants in a location that cant support its growth. An ectopic pregnancy most often happens in your fallopian tube (a structure that connects your ovaries and uterus). Ectopic pregnancies more rarely can occur in your ovary, abdominal cavity or cervix. Pregnancies cant continue if theyre ectopic because only your uterus is meant to carry a pregnancy. […] Ectopic pregnancies can become life-threatening, especially if your fallopian tube breaks (ruptures). This is a ruptured ectopic pregnancy, and it can cause severe bleeding, infection and sometimes, death. This is a medical emergency. Healthcare providers must treat ectopic pregnancies quickly. […] To diagnose an ectopic pregnancy, your provider will perform several tests. This may include a pelvic exam and confirmation of pregnancy. These tests include:

• #3 Diagnosis and Management of Ectopic Pregnancy | AAFP

  https://www.aafp.org/pubs/afp/issues/2005/1101/p1707.html

  Ectopic pregnancy is a high-risk condition that occurs in 1.9 percent of reported pregnancies. The condition is the leading cause of pregnancy-related death in the first trimester. If a woman of reproductive age presents with abdominal pain, vaginal bleeding, syncope, or hypotension, the physician should perform a pregnancy test. If the patient is pregnant, the physician should perform a work-up to detect possible ectopic or ruptured ectopic pregnancy. Prompt ultrasound evaluation is key in diagnosing ectopic pregnancy. Equivocal ultrasound results should be combined with quantitative beta subunit of human chorionic gonadotropin levels. If a patient has a beta subunit of human chorionic gonadotropin level of 1,500 mIU per mL or greater, but the transvaginal ultrasonography does not show an intrauterine gestational sac, ectopic pregnancy should be suspected.

• #4 Diagnosis and management of ectopic pregnancy

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3213855/

  An ectopic pregnancy occurs when a fertilised ovum implants outside the normal uterine cavity. It is a common cause of morbidity and occasionally of mortality in women of reproductive age. Its diagnosis can be difficult. In current practice, in developed countries, diagnosis relies on a combination of ultrasound scanning and serial serum beta-human chorionic gonadotrophin (-hCG) measurements. […] Diagnosis of ectopic pregnancy has improved significantly due to advances in ultrasound technology, rapid and sensitive serum hormone assays, the development of EPUs and an increased awareness and understanding of the associated risk factors. Despite this, around half of the women with an eventual diagnosis of ectopic pregnancy are not diagnosed at their first presentation. Early diagnosis reduces the risk of tubal rupture and allows more conservative medical treatments to be employed.

• #5 70 Basic icons by Xicons.co

  https://ectopic.org.uk/diagnosing-an-ectopic-pregnancy

  Ectopic pregnancy diagnosis can be difficult based on symptoms alone because it often causes symptoms that can mimic other, more common, conditions such as gastroenteritis, miscarriage, pelvic inflammatory disease (PID), endometriosis or even appendicitis. […] Doctors rely on having clear information about symptoms and so the more you can tell a doctor about what has changed, what feels different, and what is worrying you, the more likely they are to be able to make a quick, accurate, and early diagnosis. […] In diagnosing an ectopic pregnancy, medical professionals are likely to undertake some or all of the following tests. […] An initial transvaginal scan will detect over 70% of ectopic pregnancies, and most ectopic pregnancies will be seen as an area of pregnancy tissue, with or without a gestational sac, a fetal pole or a beating heart that is not correctly placed in the uterus.

• #6 Ectopic Pregnancy, Ultrasound – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK482192/

  Ectopic pregnancy is a diagnosis that is quite challenging to make. It has been estimated that 40% of ectopic pregnancies go undiagnosed on initial presentation. Ectopic pregnancy is also a very difficult condition to identify based on history and physical, with both the history and physical examination features being neither sensitive nor specific for the diagnosis. Data suggests that even experienced gynecologists are unable to detect more than half of the masses created by ectopic pregnancy on physical exam. […] Due to the nature of the condition, laboratory data and diagnostic imaging are essential components of diagnosing ectopic pregnancy. Ultrasonography is the diagnostic imaging study of choice for ectopic pregnancy. Even if an ectopic pregnancy cannot be visualized on ultrasound, diagnosing an intrauterine pregnancy greatly reduces the risk of an ectopic pregnancy being present.

• #7 Diagnosis and Management of Ectopic Pregnancy | AAFP

  https://www.aafp.org/pubs/afp/issues/2005/1101/p1707.html

  Diagnostic tests for ectopic pregnancy include a urine pregnancy test; ultrasonography; beta-hCG measurement; and, occasionally, diagnostic curettage. […] Ultrasonography is the diagnostic test of choice, with limitations largely based on availability and the gestational age of the pregnancy. Ectopic pregnancy is suspected if transabdominal ultrasonography does not show an intrauterine gestational sac and the patients beta-hCG level is greater than 6,500 mIU per mL (6,500 IU per L) or if transvaginal ultrasonography does not show an intrauterine gestational sac and the patients beta-hCG level is 1,500 mIU per mL (1,500 IU per L) or greater. […] Combined transvaginal ultrasonography and serial quantitative beta-hCG measurements are approximately 96 percent sensitive and 97 percent specific for diagnosing ectopic pregnancy. Therefore, transvaginal ultrasonography followed by quantitative beta-hCG testing is the optimal and most cost-effective strategy for diagnosing ectopic pregnancy.

• #8 Ectopic pregnancy – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/ectopic-pregnancy/diagnosis-treatment/drc-20372093

  A pelvic exam can help your doctor identify areas of pain, tenderness, or a mass in the fallopian tube or ovary. However, your doctor can’t diagnose an ectopic pregnancy by examining you. You’ll need blood tests and an ultrasound. […] Your doctor will order the human chorionic gonadotropin (HCG) blood test to confirm that you’re pregnant. Levels of this hormone increase during pregnancy. This blood test may be repeated every few days until ultrasound testing can confirm or rule out an ectopic pregnancy usually about five to six weeks after conception. […] A transvaginal ultrasound allows your doctor to see the exact location of your pregnancy. For this test, a wandlike device is placed into your vagina. It uses sound waves to create images of your uterus, ovaries and fallopian tubes, and sends the pictures to a nearby monitor.

• #9 Ectopic Pregnancy: Causes, Symptoms & Treatments

  https://my.clevelandclinic.org/health/diseases/9687-ectopic-pregnancy

  A blood test: You provider may test your blood to see how much of the hormone human chorionic gonadotropin (HCG) you have in your body. Your body only makes HCG during pregnancy. A low amount may indicate an ectopic pregnancy because HCG levels increase dramatically when a fertilized egg implants in your uterus. […] Once your provider has confirmed an ectopic pregnancy and determined where the fertilized egg has implanted, theyll discuss a treatment plan with you. An ectopic pregnancy is an emergency and treatment is very important. […] Healthcare providers treat ectopic pregnancies with medication or surgery. […] Your provider will want to remove the ectopic pregnancy with surgery if your fallopian tube has ruptured or if youre at risk of rupture. This is an emergency surgery and a life-saving treatment.

• #10 Will a Pregnancy Test Show an Ectopic Pregnancy?

  https://www.parents.com/pregnancy/complications/testing-for-ectopic-pregnancy-what-to-expect/

  Getting a diagnosis early reduces the risk of complications like fallopian tube rupture and internal bleeding. […] If the health care provider thinks you may be pregnant, they’ll test your blood or urine for human chorionic gonadotropin (hCG). […] Your health care provider may have already tested hCG levels to confirm a pregnancy, but according to Dr. Levie, they might also do a quantitative hCG test, which measures the exact level of hCG in the blood. […] If ectopic pregnancy symptoms are severe the health care provider may immediately treat the ectopic pregnancy. […] If they notice painful areas or a tender mass in the fallopian tube, they might suspect ectopic pregnancy. More testing is necessary to confirm the diagnosis. […] Health care providers may use an abdominal ultrasound or transvaginal ultrasound (a device placed into the vagina that creates images through sound waves).

• #11 History and Diagnosis – Ectopic Pregnancy Foundation

  https://www.ectopicpregnancy.co.uk/for-professionals/aspects-of-care/history-and-diagnosis/

  Because of the development of a rapid test for the beta subunit of human chorionic gonadotropin (hCG) and the development of high-quality ultrasound images, ectopic pregnancy is now frequently diagnosed early and treated before it can cause morbidity or mortality. […] The quantitative level of beta-hCG found in ectopic pregnancy varies. Serum beta-hCG levels correlate with the size and gestational age in normal embryonic growth. In a normal pregnancy, the beta-hCG level doubles every 48 hours until it reaches 10,000-20,000 mIU/mL. With ectopic pregnancies, beta-hCG levels usually increase less. The discriminatory zone of beta-hCG is the level above which a normal intrauterine pregnancy (IUP) is reliably visualised. Once beta-hCG has reached a level of 2000 mIU/mL, a gestational sac should be seen within the uterus on transvaginal ultrasound scan images. Once it has reached 6000 mIU/mL, a gestational sac should be visualised within the uterus on abdominal scan images. Endovaginal ultrasonography to exclude an IUP can be performed in the outpatient clinic or emergency department.

• #12 The Diagnosis and Treatment of Ectopic Pregnancy (09.10.2015)

  https://www.aerzteblatt.de/int/archive/article/172413

  The role of serum biochemical tests The serum marker hCG plays an important role alongside ultrasonography in the diagnostic evaluation of pregnancy of unknown location. […] Ectopic pregnancy is generally associated with a rise in hCG by no more than 66%, or a fall by no more than 13% from the baseline level, in 48 hours. […] The medical treatment of tubal pregnancy is an acceptable option only for very strict indications, and only when the patient can be safely expected to comply with the physicians recommendations.

• #13 Incidence, diagnosis and management of tubal and nontubal ectopic pregnancies: a review | Fertility Research and Practice | Full Text

  https://fertilityresearchandpractice.biomedcentral.com/articles/10.1186/s40738-015-0008-z

  Ectopic pregnancy is a potentially life-threatening condition occurring in 1-2 % of all pregnancies. […] Diagnosis involves a combination of clinical symptoms, serology, and ultrasound. […] Following tubal ectopic pregnancy, the rate of subsequent intrauterine pregnancy is high and independent of treatment modality. […] The diagnosis of EP often begins with the preliminary diagnosis of pregnancy of unknown location (PUL). […] In the stable patient, measurement of -hCG is crucial to clarify pregnancy location and prognosis. […] Serum progesterone has been explored as a possible serum marker for nonviable pregnancies, including EPs, as progesterone levels have been shown to be lower in ectopic and failing pregnancies than IUPs. […] The diagnosis of EP by ultrasound is possible when following careful guidelines.

• #14 Ectopic Pregnancy: Practice Essentials, Background, Etiology

  https://emedicine.medscape.com/article/2041923-overview

  Ectopic pregnancy is the result of a flaw in human reproductive physiology that allows the conceptus to implant and mature outside the endometrial cavity, which ultimately ends in the death of the fetus. Without timely diagnosis and treatment, ectopic pregnancy can become a life-threatening situation. […] No single serum -HCG level is diagnostic of an ectopic pregnancy. Serial serum -HCG levels are necessary to differentiate between normal and abnormal pregnancies and to monitor resolution of ectopic pregnancy once therapy has been initiated. […] Ultrasonography is probably the most important tool for diagnosing an extrauterine pregnancy. […] Laparoscopy remains the criterion standard for diagnosis; however, its routine use on all patients suspected of ectopic pregnancy may lead to unnecessary risks, morbidity, and costs.

• #15 Non-tubal Ectopic Pregnancy: Diagnosis and Management | IntechOpen

  https://www.intechopen.com/chapters/69913

  Ectopic pregnancy is the leading cause of maternal mortality in the first trimester, and prompt diagnosis and intervention are essential to ameliorate its associated complications. […] Early diagnosis of extra-tubal pregnancies requires high index of suspicion using transvaginal ultrasound and at times complemented with the help of magnetic resonance imaging. […] Ectopic pregnancy is usually diagnosed on TVUS as the presence of a mass with hyperechoic ring around the gestational sac (bagel sign) or a gestational sac with a fetal pole with or without cardiac activity. […] The sensitivity and specificity of TVUS in detecting ectopic pregnancy are 90.9 and 99.9%, respectively, with positive and negative predict values of 93.5 and 99.8%, respectively. […] Magnetic resonance imaging is useful as a troubleshooting tool when ultrasound is equivocal or inconclusive before intervention or therapy.

• #16 Diagnosis and management of ectopic pregnancy

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3213855/

  Currently, diagnosis in unruptured ectopic pregnancy is achieved using a combination of transvaginal ultrasonography and measurement of serum -hCG concentrations. One of the key elements in the diagnosis is the exclusion of a viable or non-viable IUP. […] In the absence of an intrauterine gestation sac, an ectopic pregnancy can be diagnosed by the presence of an adnexal mass, often visible within the Fallopian tube. The positive identification of a non-cystic adnexal mass with an empty uterus has a sensitivity of 84-90% and a specificity of 94-99% for the diagnosis of an ectopic gestation. […] If the history is not compatible with a spontaneous abortion, or the -hCG concentrations continue to rise and the scan location of the pregnancy is still unknown, an ectopic pregnancy is likely and a clear management strategy should be put in place.

• #17 Ectopic pregnancy – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/ectopic-pregnancy/diagnosis-treatment/drc-20372093

  Abdominal ultrasound, in which an ultrasound wand is moved over your belly, may be used to confirm your pregnancy or evaluate for internal bleeding. […] A complete blood count will be done to check for anemia or other signs of blood loss. If you’re diagnosed with an ectopic pregnancy, your doctor may also order tests to check your blood type in case you need a transfusion. […] If the ectopic pregnancy is causing heavy bleeding, you might need emergency surgery. This can be done laparoscopically or through an abdominal incision (laparotomy). In some cases, the fallopian tube can be saved. Typically, however, a ruptured tube must be removed.

• #18 Ectopic Pregnancy Diagnosis: How to Recognize Early Signs

  https://www.webmd.com/baby/pregnancy-ectopic-pregnancy

  Your doctor will probably do tests that include a pregnancy test and a pelvic exam. They might give you an ultrasound to look at your uterus and fallopian tubes. […] An ultrasound for ectopic pregnancy is a noninvasive test that uses sound waves to create images of the inside of the uterus. The test is performed by a sonographer and may be done transvaginally or transabdominally. During the ultrasound, the doctor will look for the presence of a gestational sac, the location of the gestational sac, and whether there is a fetal heartbeat. The test is painless and usually takes around 15 to 20 minutes. […] An abdominal ultrasound test, which is performed by moving a wand over the abdomen, may be used to confirm pregnancy or check for internal bleeding.

• #19

  https://www.nhs.uk/conditions/ectopic-pregnancy/diagnosis/

  It can be difficult to diagnose an ectopic pregnancy from the symptoms alone, as they can be similar to other conditions. […] If you have the symptoms of an ectopic pregnancy and a positive pregnancy test, you may be referred to an early pregnancy assessment service for further testing. […] An ectopic pregnancy is usually diagnosed by carrying out a transvaginal ultrasound scan. […] Blood tests to measure the pregnancy hormone human chorionic gonadotropin (hCG) may also be carried out twice, 48 hours apart, to see how the level changes over time. […] This can be a useful way of identifying ectopic pregnancies that aren’t found during an ultrasound scan, as the level of hCG tends to be lower and rise more slowly over time than in a normal pregnancy. […] If it’s still not clear whether you have an ectopic pregnancy or the location of the pregnancy is unknown, a laparoscopy may be carried out. […] Your doctor uses the laparoscope to examine the womb and fallopian tubes directly. […] If an ectopic pregnancy is found during the procedure, small surgical instruments may be used to remove it to avoid the possible need for a second operation later on.

• #20 Ectopic Pregnancy: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2020/0515/p599.html

  A combination of -hCG level greater than the discriminatory level and ultrasonography that does not show an intrauterine pregnancy should raise concern for early pregnancy loss or an ectopic pregnancy. […] Intrauterine pregnancy visualized on transvaginal ultrasonography essentially rules out ectopic pregnancy except in the exceedingly rare case of heterotopic pregnancy. […] The definitive diagnosis of ectopic pregnancy can be made with ultrasonography when a yolk sac and/or embryo is seen in the adnexa; however, ultrasonography alone is rarely used to diagnose ectopic pregnancy because most do not progress to this stage. […] In a desired pregnancy, -hCG levels and serial ultrasonography combined with patient reports of pain or bleeding guide management. […] If chorionic villi are seen, further workup is unnecessary, and exposure to methotrexate can be avoided. […] If chorionic villi are not seen after uterine aspiration, it is imperative to initiate treatment for ectopic pregnancy or repeat -hCG measurement in 24 hours to ensure at least a 50% decrease.

• #21 Ectopic Pregnancy Workup: Approach Considerations, Beta–Human Chorionic Gonadotropin Levels, Progesterone Levels

  https://emedicine.medscape.com/article/2041923-workup

  However, although free fluid can represent hemoperitoneum, it is not specific for ruptured ectopic pregnancy. […] An empty uterus on endovaginal ultrasonographic images in patients with a serum betahuman chorionic gonadotropin (-HCG) level greater than the discriminatory cutoff value is an ectopic pregnancy until proven otherwise. […] In the presence of a definite ectopic pregnancy, a thick, brightly echogenic, ringlike structure is located outside the uterus, with a gestational sac containing an obvious fetal pole, a yolk sac, or both. […] A simple way to rule out an ectopic pregnancy is to establish the presence of an intrauterine pregnancy. […] Once the presence of an abnormal pregnancy has been established by assessing betahuman chorionic gonadotropin (-HCG) or progesterone levels, dilatation and curettage can provide a rapid, cost-effective method to help differentiate between an intrauterine and an ectopic pregnancy.

• #22

  https://www.saem.org/about-saem/academies-interest-groups-affiliates2/cdem/for-students/online-education/m4-curriculum/group-m4-genitourinary/ectopic-pregnancy—genitourinary

  The presence of an adnexal mass or tubal ring sign without an IUP is concerning for EP. […] The more complex diagnostic dilemma arises when neither an IUP nor an adnexal mass is appreciated on ultrasound because early pregnancy, abnormal IUP/spontaneous abortion, and EP remain possible. […] Although rarely used since ultrasound became readily available, culdocentesis is a bedside procedure that can be performed to detect intraperitoneal blood in unstable patients with suspected EP. […] Management options for patients with suspected or confirmed EP include expectant management, medical therapy, or operative intervention. […] Surgical intervention is required for patients who are hemodynamically unstable, have a ruptured EP, or cannot receive or have failed methotrexate therapy. […] Patients with pregnancy of unknown location and -hCG above the discriminatory zone should receive OB-GYN consultation.

• #23 Ectopic Pregnancy | ACOG

  https://www.acog.org/womens-health/faqs/ectopic-pregnancy

  An ectopic pregnancy occurs when a fertilized egg grows outside of the uterus. Almost all ectopic pregnancies—more than 90%—occur in a fallopian tube. As the pregnancy grows, it can cause the tube to burst (rupture). A rupture can cause major internal bleeding. This can be a life-threatening emergency that needs immediate surgery. […] If you do not have the symptoms of a fallopian tube rupture but your ob-gyn or other health care professional suspects you may have ectopic pregnancy, he or she may: Perform a pelvic exam, Perform an ultrasound exam to see where the pregnancy is developing, Test your blood for a pregnancy hormone called human chorionic gonadotropin (hCG). […] If the ectopic pregnancy has ruptured a tube, emergency surgery is needed. Sometimes surgery is needed even if the fallopian tube has not ruptured. In these cases, the ectopic pregnancy can be removed from the tube, or the entire tube with the pregnancy can be removed. […] Surgery typically is done with laparoscopy. This procedure uses a slender, lighted camera that is inserted through small cuts in the abdomen. It is done in a hospital with general anesthesia.

• #24 70 Basic icons by Xicons.co

  https://ectopic.org.uk/diagnosing-an-ectopic-pregnancy

  If pregnancy cannot be seen inside or outside the uterine cavity (womb), or if the sonographer is not certain, you may hear this situation being classified as a Pregnancy of Unknown Location, or PUL. […] It is also important to note that this classification does not necessarily mean there is an ectopic pregnancy, as PUL also include healthy intrauterine pregnancies that are initially too small to see on ultrasound scans as well as failing pregnancies that are too small to visualise. […] For every 100 pregnancies initially classified as a PUL, approximately 12 will subsequently receive an ectopic pregnancy diagnosis. […] HCG is also used to help decide the best treatment for ectopic pregnancy. […] Ectopic pregnancy might be treated with methotrexate if hCG levels are not more than 5000 IU/l and depending on the clinical situation. […] If there is internal bleeding as a result of ruptured ectopic pregnancy, emergency surgery is essential for this life-threatening condition.

• #25 Ectopic Pregnancy: Signs, Treatment and SupportCloseleft-arrowleft-arrowleft-arrowleft-arrowleft-arrowleft-arrowCloseReconfirm cookies choice

  https://www.tommys.org/baby-loss-support/ectopic-pregnancy-information-support

  Sometimes a pregnancy can’t be seen on the ultrasound scan, even if you have had a positive pregnancy test. This is called a ‘pregnancy of unknown location’ (PUL). […] To find out what has happened, further tests are carried out. Blood tests may be done 48 hours apart to look for changes in pregnancy hormones. These can help tell if the pregnancy is ectopic, but it can be difficult to get a definite diagnosis. You may be offered further transvaginal ultrasound scans and blood tests.

• #26 Investigation report: The diagnosis of ectopic pregnancy

  https://www.hssib.org.uk/patient-safety-investigations/the-diagnosis-of-ectopic-pregnancy/investigation-report/

  A transvaginal ultrasound scan (TVUS) is the most common way to diagnose an ectopic pregnancy. With increasingly high-resolution ultrasound and expert operators, TVUS is accurate in the diagnosis of ectopic pregnancy. In a study of over 5,000 women attending an early pregnancy service, 73.9% of ectopic pregnancies were diagnosed on the first TVUS. […] […] Not all ectopic pregnancies can be seen on TVUS. Those women with a positive pregnancy test but whose pregnancy was not identified during a scan are considered to have a pregnancy of unknown location (PUL). These women must be followed up by early pregnancy services, as a proportion will be at risk of an ectopic pregnancy that was not visualised on the initial scan. […] […] The NICE clinical guideline for ectopic pregnancy and miscarriage contains advice about potential differential diagnoses based on the clinical symptoms with which a woman with an ectopic pregnancy may present: the symptoms and signs of ectopic pregnancy can resemble the common symptoms and signs of other conditions for example, gastrointestinal conditions or urinary tract infection. […] […] The investigation confirmed that the only reliable method of diagnosing an ectopic pregnancy or miscarriage was through a TVUS, which the doctor referred Abby for at the end of their assessment.

• #27 Ectopic Pregnancy: Causes, Symptoms & Treatments

  https://my.clevelandclinic.org/health/diseases/9687-ectopic-pregnancy

  An ectopic pregnancy is a medical emergency. Your uterus is the only organ that can hold a growing fetus. It can stretch and expand as the fetus grows. Your fallopian tubes arent as flexible. They can burst as the fertilized egg develops. If this happens, it can cause severe, life-threatening internal bleeding. This is dangerous. An ectopic pregnancy needs to be treated right away to avoid injury to your fallopian tube and other organs, internal bleeding and possibly, death. […] Unfortunately, an ectopic pregnancy is fatal for the fetus and your pregnancy cant continue. Once an egg implants outside your uterus, you cant move it to your uterus. Prompt treatment for an ectopic pregnancy is important. If the egg has implanted in your fallopian tube and the tube bursts, there can be severe internal bleeding.

• #28 Ectopic pregnancy – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/ectopic-pregnancy/symptoms-causes/syc-20372088

  An ectopic pregnancy occurs when a fertilized egg implants and grows outside the main cavity of the uterus. […] An ectopic pregnancy can’t proceed normally. The fertilized egg can’t survive, and the growing tissue may cause life-threatening bleeding, if left untreated. […] If you take a pregnancy test, the result will be positive. Still, an ectopic pregnancy can’t continue as normal. […] Seek emergency medical help if you have any signs or symptoms of an ectopic pregnancy, including: Severe abdominal or pelvic pain accompanied by vaginal bleeding. […] A tubal pregnancy the most common type of ectopic pregnancy happens when a fertilized egg gets stuck on its way to the uterus, often because the fallopian tube is damaged by inflammation or is misshapen. […] An ectopic pregnancy can cause your fallopian tube to burst open. Without treatment, the ruptured tube can lead to life-threatening bleeding. […] Some research suggests that women who have in vitro fertilization (IVF) or similar treatments are more likely to have an ectopic pregnancy.

• #29 Identification of noninvasive diagnostic biomarkers for ectopic pregnancy using data-independent acquisition (DIA)proteomics: a pilot study | Scientific Reports

  https://www.nature.com/articles/s41598-022-23374-8

  At present, the diagnosis of ectopic pregnancy mainly depends on transvaginal ultrasound and -hCG. However, these methods may delay diagnosis and treatment time. Therefore, we aimed to screen for serological molecular markers for the early diagnosis of ectopic pregnancy (EP). […] The combination of GSTO1/ECM-1/-hCG may be developed into a possible approach for the early diagnosis of EP. […] Therefore, early warning and better diagnosis of ectopic pregnancy are urgent issues. […] At present, -hCG is still the most widely used serum marker in clinical practice, but a single serum -hCG level can only reflect pregnancy but not the pregnancy location. Therefore, serum -hCG is not suitable for the diagnosis of ectopic pregnancy. […] In this study, we found that GSTO1, ECM-1 and -hCG may be serological markers for the early diagnosis of EP, especially when combining the three factors together, with the best sensitivity and specificity.

• #30 Identification of noninvasive diagnostic biomarkers for ectopic pregnancy using data-independent acquisition (DIA)proteomics: a pilot study | Scientific Reports

  https://www.nature.com/articles/s41598-022-23374-8

  Our study also confirms these findings that combining several markers into a single test with better diagnostics than individual proteins. […] In conclusion, the present study reveals that GSTO1/ECM-1/-hCG in serum may be potentially useful biomarkers for the early diagnosis of EP, which should be confirmed in studies with larger sample sizes.

• #31

  https://journals.lww.com/greenjournal/abstract/1994/12000/prompt_diagnosis_of_ectopic_pregnancy_in_an.22.aspx

  To evaluate quantitative hCG measurements and transvaginal ultrasound in the diagnosis of ectopic pregnancy in patients presenting to the emergency department. […] A discriminatory zone for detecting the presence or absence of an intrauterine pregnancy by transvaginal ultrasound was established prospectively. […] Women presenting to the emergency department were evaluated prospectively using a diagnostic algorithm consisting of clinical examination, quantitative serum hCG, and transvaginal ultrasound. […] This protocol diagnosed ectopic pregnancies with a sensitivity of 100% and a specificity of 99.9%. […] A protocol of quantitative hCG levels (available within hours of presentation to an emergency department) combined with transvaginal ultrasound is effective in diagnosing ectopic pregnancy.

• #32 Ectopic Pregnancy – Gynecology and Obstetrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/gynecology-and-obstetrics/early-pregnancy-disorders/ectopic-pregnancy

  Ectopic pregnancy is the implantation of a pregnancy in a site other than the endometrial lining of the uterine cavityie, in the fallopian tube, uterine cornua, cervix, ovary, or abdominal or pelvic cavity. […] Diagnosis is by measurement of the beta subunit of human chorionic gonadotropin and ultrasonography. […] Ectopic pregnancy is suspected in any female patient of reproductive age with pelvic pain, vaginal bleeding, or unexplained syncope or hemorrhagic shock, regardless of menstrual, contraceptive, and sexual history. […] A ruptured ectopic pregnancy is a surgical emergency because it causes maternal hemorrhage and risk of death; prompt diagnosis is essential. […] The first step in diagnosis is a urine pregnancy test, which is approximately 99% sensitive for pregnancy (ectopic and otherwise).

• #33 Diagnosis and management of ectopic pregnancy | BMJ Sexual & Reproductive Health

  https://srh.bmj.com/content/37/4/231

  Currently, diagnosis in unruptured ectopic pregnancy is achieved using a combination of transvaginal ultrasonography and measurement of serum -hCG concentrations. One of the key elements in the diagnosis is the exclusion of a viable or non-viable IUP. Diagnosis can be straightforward when a transvaginal ultrasound scan (TVS) positively identifies an IUP or ectopic pregnancy. However, TVS fails to identify the location of a pregnancy in a significant number of women and such women are currently diagnosed as having a pregnancy of unknown location (PUL). […] The 2006-2008 CMACE report drew attention to a maternal death secondary to ruptured ectopic pregnancy where a diagnosis of PUL had been made. Although most patients with a PUL will subsequently be diagnosed with either a failed IUP (a spontaneous abortion) or viable IUP, the report highlights that 7-20% will be diagnosed with an ectopic pregnancy. It is therefore very important that a diagnosis of PUL should trigger further diagnostic pathways and follow-up until the final outcome of the pregnancy is known.

• #34 Ectopic pregnancy: Prompt diagnosis spells effective treatment

  https://www.contemporaryobgyn.net/view/ectopic-pregnancy-prompt-diagnosis-spells-effective-treatment

  Skillful interpretation of ultrasound images, hCG values, and patients’ signs and symptoms can help identify ectopics early on. Once the diagnosis is made, salpingectomy, salpingostomy, and methotrexate are your therapeutic options. […] Abdominal or pelvic pain and vaginal bleeding in the first trimester of pregnancy are the most common symptoms to suggest ectopic pregnancy. However, these complaints may be inconsistent, and in some cases, absent. […] The diagnostic work-up for ectopic pregnancy requires the exclusion of an intrauterine pregnancy, since it’s very rare for ectopic and intrauterine pregnancies to occur concurrently (about one in 30,000). […] The confirmation of an intrauterine pregnancy requires the identification of a series of structures that can be visualized by U/S.

• #35 Ectopic pregnancy | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/ectopic-pregnancy?lang=us

  The ultrasound exam should be performed both transabdominal and transvaginally. The transabdominal component provides a wider overview of the abdomen, whereas a transvaginal scan is important for diagnostic sensitivity. […] Positive sonographic findings include an empty uterine cavity or no evidence of an intrauterine pregnancy. […] The presence of free intraperitoneal fluid in the context of a positive beta HCG and the empty uterus is ~70% specific for an ectopic pregnancy. […] Management depends on the location of the ectopic pregnancy and the patient’s hemodynamic status. In general, the options are surgical, medical, or conservative management.

• #36 Ectopic pregnancy – Wikipedia

  https://en.wikipedia.org/wiki/Ectopic_pregnancy

  The presence of an adnexal mass in the absence of an intrauterine pregnancy on transvaginal sonography increases the likelihood of an ectopic pregnancy 100-fold. […] A laparoscopy or laparotomy can also be performed to visually confirm an ectopic pregnancy. […] In women with a pregnancy of unknown location, between 6% and 20% have an ectopic pregnancy.

• #37 Incidence, diagnosis and management of tubal and nontubal ectopic pregnancies: a review | Fertility Research and Practice | Full Text

  https://fertilityresearchandpractice.biomedcentral.com/articles/10.1186/s40738-015-0008-z

  Identification of a gestational sac and fetal pole, with or without cardiac activity, or a hyperechoic ring called the bagel or tubal sign with circumferential Doppler flow is highly suggestive of an ectopic pregnancy. […] The most common interventions for the treatment of EP are medical management with systemic MTX and surgical removal of the pregnancy. […] Medical management of EP with MTX has been demonstrated to be more cost-effective than surgical management while maintaining similar treatment success and future fertility. […] Surgical management is indicated in patients with contraindications to medical treatment as described in the previous section, hemodynamic compromise or other clinical signs of ruptured EP including pain or evidence of intra-abdominal bleeding, and according to patient preference.

• #38 Diagnosis and treatment of ectopic pregnancy | British Columbia Medical Journal

  https://bcmj.org/articles/diagnosis-and-treatment-ectopic-pregnancy

  Ectopic pregnancy refers to implantation of an embryo outside the endometrium. It is a medical emergency, but associated maternal mortality has significantly declined over the decades due to earlier diagnosis and treatment. Timely detection of ectopic pregnancy is contingent on having a high index of suspicion in all women of reproductive age, identifying patient risk factors, and then performing appropriate laboratory testing and imaging. Early diagnosis of ectopic pregnancy is critical to reducing maternal mortality and improving treatment success rates, especially since many women have no identifiable risk factors. Thus, timely diagnosis of ectopic pregnancy is essential to prevent maternal mortality and improve treatment outcomes. Maternal mortality related to ectopic pregnancy has plummeted over the last two decades due to the availability of quantitative beta-human chorionic gonadotropin (b-hCG) testing, transvaginal ultrasound, and laparoscopy, which allow for early diagnosis and intervention. This review outlines the current practices, recent advances, and unresolved topics related to diagnosis, management, and prognosis of ectopic pregnancy. Women with an ectopic pregnancy most commonly present with abdominal pain, vaginal bleeding, or both. Initial workup includes confirmation of pregnancy (through urine or serum b-hCG testing) and a transvaginal ultrasound to determine the location of the pregnancy. Serial quantitative serum b-hCG testing can be helpful in determining if the current pregnancy is likely to be in an ectopic location. Transvaginal ultrasound is the optimal method for imaging pregnancies in the early first trimester. An intrauterine gestational sac without a yolk sac or embryo is not sufficient to rule out ectopic pregnancy and might represent a pseudosac. Transvaginal ultrasound can definitively diagnose an ectopic pregnancy if an extra-uterine gestational sac with yolk sac/embryo is visible. However, most ectopic pregnancies lack these definitive features on imaging and are often described as an inhomogeneous adnexal mass separate from the ovaries. The presence of hemoperitoneum (echogenic intraperitoneal fluid) and placental blood flow within the periphery of this mass (ring of fire) on color doppler can aid in diagnosis. Methotrexate, the most common option for treating ectopic pregnancy, was first used for this purpose in 1982. A single dose of methotrexate is administered intramuscularly based on body surface area (50 mg/m2). Its effectiveness is assessed by serial b-hCG measurements on days 4 and 7 post-treatment, then weekly until resolution. A reduction of less than 15% in b-hCG level between days 4 and 7 posttreatment may indicate that treatment is inadequate; therefore, a second dose of methotrexate might be required. With improved laparoscopic instruments and techniques, minimally invasive surgery has become the gold standard for treating ectopic pregnancy and has mostly replaced laparotomy. Laparoscopic surgery offers a safer, faster, cheaper, and more esthetic option. An understanding of the treatments, eligibility criteria, necessary follow-up, and pros and cons of each treatment option can help clinicians ensure patient safety and autonomy.

• #39 Ectopic Pregnancy – Gynecology and Obstetrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/gynecology-and-obstetrics/early-pregnancy-disorders/ectopic-pregnancy

  If ectopic pregnancy has not been confirmed and the patient is stable, serum levels of beta-hCG are measured serially on an outpatient basis (typically every 2 days). […] If beta-hCG levels do not increase as expected or if they decrease, diagnosis of spontaneous abortion or ectopic pregnancy is likely. […] Treatment usually involves methotrexate, but surgical resection is done if rupture is suspected or criteria are not met for methotrexate treatment.

• #40 Ectopic Pregnancy – Women’s Health Issues – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/women-s-health-issues/early-pregnancy-disorders/ectopic-pregnancy

  Ectopic pregnancy is attachment (implantation) of a fertilized egg in an abnormal location, such as a fallopian tube. […] Doctors base the diagnosis on results of ultrasonography to determine the location of the fetus and blood tests; often, tests need to be repeated over several days. […] Because a ruptured ectopic pregnancy can be life-threatening for a pregnant woman, prompt diagnosis is essential. […] Doctors suspect an ectopic pregnancy in a woman who is pregnant or might be pregnant and if she has lower abdominal pain or vaginal bleeding. […] If ultrasonography detects a fetus in a location other than the uterus, the diagnosis of ectopic pregnancy is confirmed. […] A diagnosis of ectopic pregnancy cannot be made by measuring hCG just once; hCG is usually measured every 2 days until an ectopic pregnancy can be confirmed or another reason for the symptoms is identified. […] If needed to confirm the diagnosis, doctors may use a viewing tube called a laparoscope, inserted through a small incision just below the navel. This procedure enables them to view an ectopic pregnancy directly.

• #41 Ectopic Pregnancy: Symptoms, Causes, and Treatments

  https://www.healthline.com/health/pregnancy/ectopic-pregnancy

  An untreated ectopic pregnancy requires prompt medical attention. […] Ectopic pregnancies can’t be diagnosed from a physical exam. However, your doctor may still perform one to rule out other factors. […] Another step to diagnosis is a transvaginal ultrasound. This involves inserting a special wand-like instrument into your vagina so that your doctor can see if a gestational sac is in the uterus. […] Your doctor may also use a blood test to determine your levels of hCG and progesterone. These are hormones that are present during pregnancy. If these hormone levels start to decrease or stay the same over the course of a few days and a gestational sac isn’t present in an ultrasound, the pregnancy is likely ectopic. […] If you’re having severe symptoms, such as significant pain or bleeding, there may not be enough time to complete all these steps. The fallopian tube could rupture in extreme cases, causing severe internal bleeding. Your doctor will then perform an emergency surgery to provide immediate treatment.

• #42

  https://www.saem.org/about-saem/academies-interest-groups-affiliates2/cdem/for-students/online-education/m4-curriculum/group-m4-genitourinary/ectopic-pregnancy—genitourinary

  Ectopic pregnancy (EP) is a cant miss diagnosis and the leading cause of maternal death in the first trimester. […] When a female patient of child-bearing age presents with any combination of abdominal pain and vaginal bleeding, EP must be considered as early diagnosis and treatment are essential to decrease maternal mortality and preserve future fertility. […] All women of childbearing age presenting with abdominal or pelvic pain and/or vaginal bleeding should have a urine pregnancy test performed upon arrival in the ED. […] If concerning signs and symptoms are present, a serum -hCG should be ordered due to the risk of false negatives with urine pregnancy tests. […] The decision to ultrasound a pregnant patient with abdominal pain and/or vaginal bleeding should not be based on the -hCG level as it cannot be used to predict the presence of an EP or an IUP.

• #43 Ectopic Pregnancy Workup: Approach Considerations, Beta–Human Chorionic Gonadotropin Levels, Progesterone Levels

  https://emedicine.medscape.com/article/2041923-workup

  Serum and urine assays for the beta subunit of human chorionic gonadotropin (bhCG) have been developed to detect a pregnancy before the first missed period. […] While some commercial urine test kits are able to detect bhCG in early gestation, they are associated with varying false-negative rates. […] In addition, the need for a quantitative value makes serum bhCG the criterion standard for biochemical testing. […] Evidence-based guidelines have been established for the diagnostic and therapeutic management of ectopic pregnancy. […] The highest adherence is the inclusion of vaginal ultrasonography in the workup (98%), whereas the lowest adherence (21%) is performing salpingostomy when the other tube is abnormal. […] Blood type, Rh type, and antibody screen should be done in all pregnant patients with bleeding to identify patients in need of RhoGAM and to ensure availability of blood products in case of excessive blood loss.

• #44 Ectopic Pregnancy Workup: Approach Considerations, Beta–Human Chorionic Gonadotropin Levels, Progesterone Levels

  https://emedicine.medscape.com/article/2041923-workup

  In women with normal baseline findings for liver function tests (LFTs), renal function tests (RFTs), and complete blood count (CBC) on day 1 of single- or double-dose methotrexate (MTX) treatment for sonographically confirmed ectopic pregnancies, it may not be necessary to repeat these studies, as there appears to be no significant difference between results on day 1 and day 7 for either MTX treatment protocol. […] Ultrasonography is probably the most important tool for diagnosing an extrauterine pregnancy, although it is more frequently used to confirm an intrauterine pregnancy. […] Visualization of an intrauterine sac, with or without fetal cardiac activity, is often adequate to exclude ectopic pregnancy. […] The value of ultrasonography is highlighted further by its ability to demonstrate free fluid in the cul-de-sac.

• #45

  https://www.nhs.uk/conditions/ectopic-pregnancy/

  An ectopic pregnancy can be serious, so it’s important to get advice right away. […] Your GP will ask about your symptoms and you’ll usually need to do a pregnancy test to determine if you could have an ectopic pregnancy. […] You may be referred to a specialist early pregnancy clinic for further assessment, where an ultrasound scan and blood tests may be carried out to confirm the diagnosis. […] There are 3 main treatments for an ectopic pregnancy: expectant management, medicine, and surgery. […] You’ll be told about the benefits and risks of each option. […] In many cases, a particular treatment will be recommended based on your symptoms and the results of the tests you have. […] Most women who have had an ectopic pregnancy will be able to get pregnant again, even if they’ve had a fallopian tube removed. […] The chances of having another ectopic pregnancy are higher if you’ve had one before, but the risk is still small.

• #46 History and Diagnosis – Ectopic Pregnancy Foundation

  https://www.ectopicpregnancy.co.uk/for-professionals/aspects-of-care/history-and-diagnosis/

  Ectopic derived from Greek ektopos simply means away from a place. An ectopic pregnancy is a pregnancy that develops outside the uterus. This happens when the fertilised egg from the ovary does not implant itself normally in the uterus. Instead, the egg develops somewhere else in the abdomen. Ectopic pregnancy is usually found in the first five to ten weeks of pregnancy. The most common place that ectopic pregnancy occurs is in one of the fallopian tubes (a so-called tubal pregnancy). Ectopic pregnancies can also be found on the outside of the uterus, on the ovaries, or attached to the bowel. The most serious complication of an ectopic pregnancy is intra-abdominal haemorrhage (severe bleeding). In the case of a tubal pregnancy, for example, as the products of conception continue to grow in the fallopian tube, the tube expands and eventually ruptures. This can be very dangerous because a large artery runs on the outside of each fallopian tube.

• #47 70 Basic icons by Xicons.co

  https://ectopic.org.uk/ectopic-pregnancy-symptoms

  Ectopic pregnancy is a common, occasionally life-threatening, condition that affects around 1 in 80 pregnancies. […] The diagnosis of ectopic pregnancy may sometimes be difficult, and symptoms may occur from as early as 4 weeks pregnant and up to 12 weeks or even later. […] If you are experiencing any of the following ectopic pregnancy symptoms, please contact your doctor/GP or your local Early Pregnancy Unit. […] Prolonged off/on light and sometimes heavy bleeding are quite often seen in ectopic pregnancy and should always prompt a pregnancy test and if positive should be urgently investigated with an Early Pregnancy Unit (EPU) referral. […] If you are in pain and/or bleeding and your home pregnancy test is negative, but you think it should be positive, ensure you are seen by a doctor urgently by attending your local Accident Emergency department or by contacting your specialist Early Pregnancy Unit.

• #48 Diagnosis and management of ectopic pregnancy | BMJ Sexual & Reproductive Health

  https://srh.bmj.com/content/37/4/231

  An ectopic pregnancy occurs when a fertilised ovum implants outside the normal uterine cavity. It is a common cause of morbidity and occasionally of mortality in women of reproductive age. The aetiology of ectopic pregnancy remains uncertain although a number of risk factors have been identified. Its diagnosis can be difficult. In current practice, in developed countries, diagnosis relies on a combination of ultrasound scanning and serial serum beta-human chorionic gonadotrophin (-hCG) measurements. Ectopic pregnancy is one of the few medical conditions that can be managed expectantly, medically or surgically. […] Diagnosis of ectopic pregnancy has improved significantly due to advances in ultrasound technology, rapid and sensitive serum hormone assays, the development of EPUs and an increased awareness and understanding of the associated risk factors. Despite this, around half of the women with an eventual diagnosis of ectopic pregnancy are not diagnosed at their first presentation. Early diagnosis reduces the risk of tubal rupture and allows more conservative medical treatments to be employed.

• #49 Diagnosis and Management of Cervical Ectopic Pregnancy

  https://exxcellence.org/list-of-pearls/diagnosis-and-management-of-cervical-ectopic-pregnancy/

  Cervical ectopic pregnancy is the rare implantation of a pregnancy in the endocervical canal and accounts for less than 1% of all ectopic pregnancies. Patients usually present with vaginal bleeding, which can be profuse and is often painless. Clinical signs may include a soft, disproportionately large or barrel-shaped cervix. The differential diagnosis are incomplete abortion and pregnancy implanted in a cesarean or hysterotomy scar. […] Transvaginal ultrasound is an important component of the diagnosis. Sonographic criteria include an empty uterus, an enlarged barrel-shaped cervix, a gestational sac completely within the cervical canal with or without cardiac activity, peritrophoblastic Doppler blood flow to the cervix, and an absent sliding sign (the intracervical sac fails to slide along the cervical canal when gentle pressure is applied to the cervix with the vaginal transducer). The presence of cardiac activity or peritrophoblastic blood flow to the cervix helps to differentiate this condition from incomplete abortion.

• #50 The diagnosis and management of interstitial ectopic pregnancies: a review | Gynecological Surgery | Full Text

  https://gynecolsurg.springeropen.com/articles/10.1186/s10397-018-1054-4

  The objective of this article is to review the published literature on the diagnosis and management of interstitial pregnancies (IPs). […] There is little consensus on the best practice for diagnosing and managing interstitial pregnancies. […] The diagnosis and management of interstitial pregnancies (IPs) remains challenging, largely due to the rarity of this diagnosis. […] Appropriate first line management is based on many factors, including the patients symptoms, timely diagnosis, size of the pregnancy, depth of surrounding myometrium, haemodynamic stability, and desires for future fertility. […] This review will perform a comprehensive and systematic review of the current evidence regarding the diagnosis and management of interstitial pregnancies, to help work toward a consensus on the appropriate management of such cases.

• #51 The diagnosis and management of interstitial ectopic pregnancies: a review | Gynecological Surgery | Full Text

  https://gynecolsurg.springeropen.com/articles/10.1186/s10397-018-1054-4

  Timely diagnosis is key to the successful management of patients with IPs. […] Diagnosing such cases may be difficult, due to the wide spectrum of presenting symptoms and signs and difficulties distinguishing an IP from an intra-uterine or isthmic tubal ectopic pregnancy. […] Since the introduction of high-resolution transvaginal ultrasonography (TVUS) and highly sensitive -hCG assays, timely and accurate diagnosis has become possible. […] The diagnosis of IP by ultrasound is based on the following criteria: the GS is located outside the uterine cavity; the interstitial part of Fallopian tube is seen adjoining the lateral aspect of the uterine cavity and GS; and the myometrial mantle extends laterally to encircle the GS. […] MRI may be used in clinically stable patients whose diagnosis remains uncertain despite having a TVUS.

• #52 The diagnosis and management of interstitial ectopic pregnancies: a review | Gynecological Surgery | Full Text

  https://gynecolsurg.springeropen.com/articles/10.1186/s10397-018-1054-4

  Expectant management is an appropriate first line approach for women with an IP and declining serum -hCG levels (irrespective of ectopic mass size and initial serum -hCG levels). […] MTX has been advocated widely in the literature; however, much of the safety data is from retrospective cohort studies which may be susceptible to selection bias. […] The success rates for MTX management vary from 79.9% for systemic MTX to 97.83% for local MTX injection; however, the numbers in these studies were small. […] It needs to be remembered that failure of medical management resulting in rupture may have catastrophic consequences. […] For this reason, surgical management with a likely higher success rate (99.16%) is becoming more popular in centres with sufficient experience. […] Laparoscopic cornuostomy is preferable to wedge resection due to the decreased intra-operative blood loss, reduced distortion of uterine anatomy and possible reduction in the risk of uterine rupture in subsequent pregnancies.

• #53 Non-tubal Ectopic Pregnancy: Diagnosis and Management | IntechOpen

  https://www.intechopen.com/chapters/69913

  The management of extra-tubal ectopic pregnancy depends on the location, size of the gestational sac, presence of fetal heart beats and symptoms at presentation. […] The definitive management of extra-tubal ectopic pregnancy involves surgical extermination of the gestational sac via laparotomy, laparoscopy, hysteroscopy or suctional curettage under ultrasound guidance. […] Methotrexate has been used successfully to treat unruptured ovarian ectopic. […] The use of Methotrexate in the medical management of ectopic pregnancy has to be thoroughly given serious consideration to avoid inadvertent administration in patient with intrauterine pregnancy. […] The success rate is also dependent on the level of serum beta hCG because single-dose systemic Methotrexate had approximately 90% success rate if the initial serum hCG level is less than 5000 mIU/ml. […] The diagnostic criteria of abdominal pregnancy as described by Studdiford in 1942 include both the tubes and ovaries are normal without evidence of recent injury, absence of utero-peritoneal fistula, and presence of a pregnancy related exclusively to the peritoneal surface.

• #54 Ectopic pregnancy: Future fertility – Mayo Clinic Health System

  https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/ectopic-pregnancy-signs-treatment-and-future-fertility

  Ectopic pregnancies may be rare. However, when an ectopic pregnancy is discovered, it needs to be taken seriously. […] Ectopic pregnancy occurs when a fertilized egg attaches itself outside of the uterus. It attaches to the fallopian tube 90% of the time. However, in other instances, it can attach to the ovary, cesarean section scar, cervix or even the abdomen. If attached to the abdomen, the danger of complications is significantly increased. […] It’s rare for an ectopic pregnancy to coexist with another normal intrauterine pregnancy. Yet it’s still possible and poses critical challenges in diagnosis and treatment. […] An ectopic pregnancy doesn’t have specific symptoms and health care professionals can easily miss it if they fail to keep it in mind. Symptoms related to ectopic pregnancy do vary between showing no symptoms, especially during the very early stages, to severe lower abdominal pain with dizziness caused by massive internal bleeding.

• #55 Incidence, diagnosis and management of tubal and nontubal ectopic pregnancies: a review | Fertility Research and Practice | Full Text

  https://fertilityresearchandpractice.biomedcentral.com/articles/10.1186/s40738-015-0008-z

  The standard surgical intervention was laparotomy until the laparoscopic approach was introduced in 1973 by Shapiro and Adler; it has since gained wide acceptance. […] Regardless of the mode of abdominal entry, two methods of excision of a tubal EP have been extensively reported: Salpingectomy, or removal of the fallopian tube in part or in full, and salpingostomy (also called salpingotomy), or removal of the EP through a tubal incision while leaving the tube in situ. […] The risk of recurrence of tubal EP ranges from 5 to 25 %. […] The risk of recurrent EP is not affected by treatment modality medical or surgical or surgical procedure. […] The reported rate of recurrent cesarean scar EP is highly variable, as high as 25 % in small series. […] The risk of recurrent cervical EP appears to be low: One recurrence was noted in a series of 34 pregnant women with prior cervical EP treated with several different modalities.

• #56 Ectopic Pregnancy Workup: Approach Considerations, Beta–Human Chorionic Gonadotropin Levels, Progesterone Levels

  https://emedicine.medscape.com/article/2041923-workup

  If the tissue obtained is positive for villi by floating in saline or by histologic diagnosis on frozen or permanent section, then a nonviable intrauterine pregnancy has occurred. […] In the absence of villi, the diagnosis of ectopic pregnancy is made. […] Laparoscopy remains the criterion standard for diagnosis; however, its routine use on all patients suspected of ectopic pregnancy may lead to unnecessary risks, morbidity, and costs.

• #57 Can an ectopic pregnancy be misdiagnosed?

  https://devonshiresclaims.co.uk/can-an-ectopic-pregnancy-be-misdiagnosed/

  Ectopic pregnancies can be diagnosed through ultrasound examinations or blood tests for the hormone human chorionic gonadotropin (hCG). […] Should an ectopic pregnancy be suspected, identifying the accurate location and type of ectopic pregnancy may require further ultrasounds or keyhole surgery. Different types of ectopic pregnancy may require different treatments. […] As ectopic pregnancies occur in the early stages of development, fertilised eggs are still small and can be difficult to identify during an ultrasound. Without obvious symptoms, misdiagnosis is possible. […] Should a doctor fail to diagnose an ectopic pregnancy or misdiagnose one, it is deemed a false negative. This may occur due to the doctor misunderstanding the symptoms presented or attributing them to another gynaecological condition, or misinterpreting the findings of tests and investigations.

• #58 70 Basic icons by Xicons.co

  https://ectopic.org.uk/ectopic-pregnancy-symptoms

  Ectopic pregnancy pain can be on one side of the tummy, or lower abdomen, or in the pelvic area. […] The risk of ectopic pregnancy is not uncommon around 1 in 80 pregnancies are ectopic. […] Your GP will likely refer you to your local Early Pregnancy Unit for an assessment by a healthcare professional. This may involve a blood test to check hormone levels and/or an ultrasound scan depending on how many weeks pregnant you are and your symptoms.

• #59 Ectopic Pregnancy, Ultrasound – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK482192/

  If the diagnosis of ectopic pregnancy is being considered, ultrasonography is an essential part of the diagnostic evaluation. Ectopic pregnancy must be considered as a potentially life-threatening diagnosis in any woman of childbearing age presenting with abdominal pain, pelvic pain, or vaginal bleeding. If a beta-human chorionic gonadotropin (hCG) is positive, an ectopic pregnancy must rise on a differential and be ruled out before a patient can be safely sent home. […] The clinical impact of diagnosis timely diagnosis of ectopic pregnancy cannot be understated. There are significant morbidity and mortality associated with ectopic pregnancy, and early diagnosis can have a significant impact in reducing both of these. […] The diagnosis and management of an ectopic pregnancy is made by an interprofessional team that includes the emergency department physician, radiologist, obstetrician, and nurse practitioner. No patient should be discharged home if an ectopic is suspected. Ectopic pregnancies are a common gynecologic emergency that typically impacts otherwise healthy individuals and can have significant morbidity and mortality.

• #60 The diagnosis and management of interstitial ectopic pregnancies: a review | Gynecological Surgery | Full Text

  https://gynecolsurg.springeropen.com/articles/10.1186/s10397-018-1054-4

  Surgical management of IPs remains an important option, as it offers definitive treatment. […] Women with IPs who are haemodynamically unstable and/or have an ultrasound suggestive of pregnancy rupture should undergo immediate surgical management. […] Advances in laparoscopic surgery allow for less invasive and less traumatic surgical options for patients with IPs than those practised historically. […] If possible, one should manage IPs using a minimally invasive approach, rather than open surgery. […] The high sensitivity of US, when sufficient expertise is available, makes it the best first line investigation that one may use to diagnose IPs. […] IPs should be managed in early pregnancy units that have experience in managing such cases. […] Conservative management (encompassing expectant and medical management) should only be offered to patients with a radiologically diagnosed IP, who are haemodynamically stable and have no obvious risks of immediate rupture, such as large gestational sac or rapidly increasing -hCG levels.

• #61 Ectopic pregnancy | RCOG

  https://www.rcog.org.uk/for-the-public/browse-our-patient-information/ectopic-pregnancy/

  If the diagnosis is still unclear, an operation under a general anaesthetic called a laparoscopy may be necessary. […] When an ectopic pregnancy is suspected or confirmed, your doctor will discuss your treatment options with you. […] The treatment options for tubal ectopic pregnancy are listed below not all may be suitable for you, so your healthcare professional should guide you in making an informed decision. […] The aim of surgery is to remove the ectopic pregnancy. […] The type of operation you have will depend on your wishes or plans for a future pregnancy and what your surgeon finds during the operation (laparoscopy). […] The treatment of a non-tubal ectopic pregnancy depends on where the pregnancy is growing. […] Treatment options may include expectant management, medical treatment with methotrexate or surgical operation. […] If the tubal or non-tubal pregnancy has burst, emergency surgery is needed to stop the bleeding.

• #62 Ectopic Pregnancy patient education booklet | ReproductiveFacts.org

  https://www.reproductivefacts.org/news-and-publications/fact-sheets-and-infographics/ectopic-pregnancy-booklet/

  Until the last 20 years, ectopic pregnancies usually were treated by total salpingectomy (removal of the entire tube) via laparotomy (major abdominal surgery). Today, most surgeries for ectopic pregnancies are performed by laparoscopy. […] If the ectopic pregnancy is diagnosed early, before the tube ruptures, a laparoscopic salpingostomy may be performed. […] A woman who has had an ectopic pregnancy has a lower chance of becoming pregnant again. In addition, her chance of having another ectopic pregnancy is higher.

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