Ectopic Pregnancy: Diagnosis and Management

Jennifer L Kulp; Kurt T Barnhart

Disclosures

Women's Health. 2008;4(1):79-87. 

In This Article

Abstract and Introduction

Abstract

The incidence of ectopic pregnancies is increasing, which may be related to better diagnostic tools as well as the increasing use of assisted reproductive technologies. However, the signs and symptoms of ectopic pregnancy can be similar to other complications of early pregnancy such as miscarriage. Diagnosis often requires serial human chorionic gonadotropin levels along with ultrasound and, in some cases, dilation and curettage. Once a diagnosis has been made, treatment options include medical therapy with methotrexate and surgery, which can often be performed via the laparoscope. Fertility rates after therapy are similar for both medically and surgically treated patients.

Introduction

The incidence of ectopic pregnancy is increasing. In 1992, the rate of ectopic pregnancies was 19.7 per 1000 in the USA, which was an increase from 4.5 per 1000 in 1970.[1] This increase may be associated with an increase in the prevalence of risk factors for ectopic pregnancy such as pelvic infections. Furthermore, we now have more specific and sensitive methods to diagnose ectopic pregnancies, including the use of high-resolution ultrasound. In patients undergoing assisted reproductive technologies, the incidence of ectopic pregnancy is approximately 2% and may also contribute to the increasing incidence of ectopic pregnancy.[56]

Maternal mortality secondary to ectopic pregnancy has been decreasing, accounting for 13% of maternal deaths in the time period from 1979 to 1986 and approximately 6% of maternal deaths from 1991 to 1999, with most being secondary to hemorrhage.[2]

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