Ectopic pregnancy is a serious condition for women and represents a significant cause of maternal death. The incidence of ectopic pregnancies is approximately 1 in 150 of natural pregnancies.
Ectopic pregnancy occurs where there is the development of a foetus at a site other than the uterus, most often in the fallopian tube but also in the ovary itself or elsewhere in the peritoneal cavity. The cause is most often the delayed passage of the ovum down the fallopian tube.
Common symptoms of ectopic pregnancy include lower abdominal pain, delayed or irregular periods followed by vaginal bleeding or brown discharge and fainting. However, subacute presentations can exhibit localised abdominal pain to one side, delayed menstruation and episodes of vaginal bleeding. There may also be referred pain to the shoulder.
Diagnosis of ectopic pregnancy is reached through serial B hCG and transvaginal ultrasonography or salpingostomy by laparoscopy.
Previously, treatment was in the form of a salpingostomy to remove the mass from the tube, salpingectomy to remove the fallopian tube or oopherectomy to remove both ovary and tube by laparoscopy or laparotomy depending on the site of the pregnancy and the clinical state of the tube and control of bleeding.
Where diagnosed early (prior to tubal rupture) ectopic pregnancy may be treated other than surgically by expectant management (effectively wait and watch) or medically with systemic Methotrexate or by local injection of drugs into the gestational sac.
Methotrexate is a chemotherapy drug otherwise used to treat cancer. In the context of an ectopic pregnancy Methotrexate is appropriate where patients have subacute or asymptomatic presentations. The pregnancy must be less than 4 cm, and an unruptured tube without active bleeding.
Methotrexate can cause the reduction in size of the ectopic gestation and cause tubal abortion.
In all circumstances ectopic pregnancies should be dealt with by experienced obstetricians or in early pregnancy units.
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