Overview and Management of Tubal Ectopic Pregnancy

Ectopic pregnancy is a potentially life-Threatening condition that occurs in 0.64%-2.0% of all pregnancies. The most-common site for ectopic pregnancy is the fallopian tube. Ectopic pregnancy should be considered in the differential diagnosis for all patients with early pregnancies presenting with abdominopelvic pain or vaginal bleeding. Risk factors for ectopic pregnancy include prior history of an ectopic pregnancy, prior tubal surgery, and pelvic inflammatory disease. This diagnosis is made based on clinical history, examination, ultrasonography, and human chorionic gonadotropin (hCG) levels. Arriving at this diagnosis can be a nuanced process that often requires serial hCG levels and pelvic ultrasounds. Ectopic pregnancy can be managed medically, surgically, and, in selected patients, expectantly. Medical management utilizes methotrexate (MTX) to arrest the growth of the ectopic pregnancy, leading to eventual involution. MTX can be prescribed in single-dose, 2-dose, or multiple-dose protocols. Patients receiving MTX should be selected carefully based on absolute and relative contraindication criteria and should be counseled that a ruptured ectopic pregnancy requiring emergent surgery is still possible. Surgical treatment of ectopic pregnancy is performed preferentially via laparoscopy, and the affected fallopian tube can be excised (salpingectomy) or preserved with removal of the suspected ectopic pregnancy (salpingostomy).