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Clinical Diagnosis and Treatment of Ectopic Pregnancy

Alkatout, Ibrahim MD, MA*; Honemeyer, Ulrich; Strauss, Alexander PhD, MD*; Tinelli, Andrea MD; Malvasi, Antonio MD§; Jonat, Walter*; Mettler, Liselotte*; Schollmeyer, Thoralf*

Obstetrical & Gynecological Survey: August 2013 - Volume 68 - Issue 8 - p 571–581
doi: 10.1097/OGX.0b013e31829cdbeb

Background Implantation of the zygote outside the uterine cavity occurs in 2% of all pregnancies. The product of conception can be removed safely by laparoscopic surgery and be submitted for histological examination. The rate of ectopic pregnancies has increased from 0.5% in 1970 to 2% today. The prevalence of ectopic pregnancy in all women presenting to an emergency department with first-trimester bleeding, lower abdominal pain, or a combination of the 2 is between 6% and 16%.

Designation Workup of all localizations of ectopic pregnancies at a university department of obstetrics and gynecology.

Methods Comparison of diagnostic and therapeutic modalities from the surgical laparoscopic approach to nonsurgical, medical options.

Findings Surgical treatment: Tubal pregnancies: (1) to preserve tubal function, salpingotomy, partial salpingectomy followed by laparoscopic anastomosis, or fimbrial milking is performed. (2) Tubectomy or salpingectomy is performed only in severely damaged or ruptured tubes or if the patient does not desire further pregnancies. Nontubal ectopic pregnancies (ovarian pregnancy, ectopic abdominal pregnancy, interstitial or cornual pregnancy/rudimentary horn, intraligamental and cervical pregnancies) all require their own specific treatment.

Medical treatment The predominant drug is methotrexate, but other systemic drugs, such as actinomycin D, prostaglandins, and RU 486, can also be applied.

Complications Tubal rupture is a complication of late diagnosed tubal pregnancy that is more difficult to treat conservatively and often indicates tubectomy or segmental resection. In 5% to 15% of treated ectopic pregnancy cases, remnant conception product parts may require a final methotrexate injection.

Conclusions This article is a review to aid clinical diagnosis of ectopic pregnancies that now can be diagnosed earlier and treated effectively by laparoscopic surgery.

Target Audience Obstetricians and gynecologists, family physicians

Learning Objectives After completing this CME activity, obstetricians and gynecologists should be better able to diagnose ectopic pregnancy in its early stages to provide safe treatment, choose the appropriate treatment for patients with ectopic pregnancy, and identify the role that human chorionic gonadotropin plays in ectopic pregnancy.

*Doctor, Kiel School of Gynaecological Endoscopy, Department of Gynaecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, Kiel, Germany; †Doctor, Department of Obstetrics and Gynaecology, Welcare Hospital EHL, Dubai, United Arab Emirates; ‡Doctor, Department of Obstetrics and Gynecology, Vito Fazzi Hospital, Lecce; and §Doctor, Department of Obstetrics and Gynecology, Santa Maria Hospital, Bari, Italy

All authors and staff in a position to control the content of this CME activity and their spouses/life partners (if any) have disclosed that they have no financial relationships with, or financial interests in, any commercial organizations pertaining to this educational activity.

Correspondence requests to: Ibrahim Alkatout, MD, MA, Department of Gynaecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller Strasse 3, House 24, 24105 Kiel, Germany. E-mail:

© 2013 by Lippincott Williams & Wilkins.