The most common gestational age at diagnosis is 6 to 10 weeks, but fetal viability can be discovered until the time of delivery. Pregnancy of unknown location pul is the term used to categorize a pregnancy in a woman with a positive pregnancy test when no pregnancy has been visualized using tvs. The following ultrasound criteria may be used for the diagnosis of cervical ectopic pregnancy. Early diagnosis and management of ectopic pregnancy. Diagnosing such cases may be difficult, due to the wide spectrum of presenting symptoms and signs and difficulties distinguishing an ip from an intrauterine or isthmic tubal ectopic pregnancy.
Ectopic pregnancy remains to be an important cause of maternal morbidity and mortality worldwide, although the incidence has remained unchanged especially in developed countries over the last decade. Ectopic pregnancy is a potentially lifethreatening condition occurring in 12 % of all pregnancies. There is no consensus regarding the ultrasound criteria necessary for the diagnosis of intramural pregnancy, and management strategies vary depending on the severity of clinical presentation, exact location of the. Some women diagnosed with an ectopic pregnancy do not even know they are pregnant and suddenly must contemplate the possibility of major surgery or medical. Early diagnosis and management of ectopic pregnancy the practice committee of the american society for reproductive medicine american society for reproductive medicine, birmingham, alabama historically, women with ectopic pregnancy typically presented with the triad of delayed menses, pain and abnormal bleeding, and were. Diagnosis and management of ectopic pregnancy vanitha n sivalingam,1 w colin duncan,2 emma kirk,3 lucy a shephard,4 andrew w horne5 key message points clinicians should be suspicious of ectopic pregnancy in any woman of reproductive age presenting with abdominal or pelvic symptoms. This guideline replaces the management of tubal pregnancy, which was published in 2004.
Diagnosis and management of ectopic pregnancy ngozi c. Previous tubal surgery including female sterilisation and pelvic surgery. Diagnosis and management of ectopic pregnancy mcgill university. The diagnosis of ectopic pregnancy requires differentiating it from a viable intrauterine pregnancy. Learn more from webmd about the symptoms, causes, and treatment of an. An ectopic pregnancy occurs when an embryo implants somewhere other than the uterus, such as in one of the fallopian tubes.
Interstitial ectopic pregnancy, diagnosis and management. Pallor, tachycardia and hypotension should alert the examiner to major abdominal bleeding, regardless of the intensity of abdominal pain. The diagnosis of ectopic pregnancy is based upon a combination of measurement of the serum quantitative human chorionic gonadotropin and findings on transvaginal ultrasonography. Timely diagnosis is key to the successful management of patients with ips. This conservative management was decided upon given her desire of future fertility. The diagnosis and management of pregnancy of unknown location will not be covered.
After an ectopic pregnancy has been confirmed, treatment options include medical, surgical, or expectant management. Pdf diagnosis and management of ectopic pregnancy green. This guideline will cover the following ectopic pregnancies. Clinicians undertaking ultrasound for the diagnosis of ectopic pregnancy must have received appropriate training. Although the incidence increased by a factor of three to six between 1970 and 1996, it has since remained stable, especially in developed countries 3,4. Diagnosis and management of ectopic pregnancy researchgate.
This topic will focus mainly on the diagnosis of tubal pregnancy. Its very important that the diagnosis of ectopic pregnancy. Pathology confirmed the diagnosis of intramural ectopic pregnancy with the identification of chorionic villi. Following tubal ectopic pregnancy, the rate of subsequent intrauterine pregnancy is high and independent of treatment modality. The recommendations in this guideline represent the view of nice, arrived at after careful consideration of the evidence available. The diagnosis and management of interstitial ectopic. Clinicians undertaking the surgical management of ectopic pregnancy must have received appropriate training. Ectopic pregnancy affects 1% to 2% of all pregnancies and is responsible for 9% of pregnancyrelated deaths in the united states. A diagnosis of pregnancy of unknown location should trigger further diagnostic pathways and followup until the final outcome of the pregnancy is known. However, tubal ectopic pregnancy in an unstable patient is a medical emergency that requires prompt surgical intervention. Today, sensitive beta human chorionic gonadotropin. Its prevalence continues to rise because of increases in the incidence of the risk factors predisposing to ectopic pregnancy. The diagnosis of ectopic pregnancy can be difficult and protracted.
Diagnosis there is some variation in the presentation of women experiencing ectopic pregnancy. By providing information to patients nurses may well be able to prevent rupture and aid early diagnosis of ectopic pregnancy, thus not only minimising the need for major surgery but also. Ectopic pregnancy symptoms, diagnosis and treatment. However, the case fatality rate has decreased over recent years, suggesting that earlier diagnosis and treatment may have made an impact. The aetiology of ectopic pregnancy remains uncertain although a number of risk factors have been identified. Diagnosis and management of ectopic pregnancy aafp. Diagnosis and management of ectopic pregnancy greentop guideline no. Diagnosis and management of ectopic pregnancy 2016.
Ectopic pregnancy diagnosis and treatment mayo clinic. Laparoscopic surgery requires appropriate equipment and trained theatre staff. Many women are in the midst of enjoying their pregnancy when they receive the diagnosis. This guidance has been updated and replaced by ectopic pregnancy and miscarriage. The intramural ectopic pregnancy was successfully removed, and the patient was discharged home in stable condition on postoperative day 1. Delayed diagnosis of interstitial pregnancy is the main factor contributing to the high maternal mortality rate in comparison to that for tubal ectopic pregnancies. Medical management with methotrexate is successful for small, stable ectopic pregnancies. More than a third of women who died from ectopic pregnancy in the uk since 1997 were misdiagnosed initially with a gastrointestinal problem. Diagnosing ectopic pregnancy and current concepts in the.
Diagnosis and management of intramural ectopic pregnancy. Diagnosis and management of ectopic pregnancy article pdf available in journal of family planning and reproductive health care 374. Classically, the diagnosis is based on a history of pelvic pain associated with amenorrhoea, a positive pregnancy. Ectopic pregnancy is the gynaecological emergency par excellence and remains the leading cause of pregnancy related first trimester deaths in the uk. Ectopic pregnancies are an important cause of morbidity and mortality in early pregnancy. Historically, women with ectopic pregnancy typically presented with the triad of delayed menses, pain and abnormal bleeding, and were treated by laparotomy and salpingectomy.
Ectopic pregnancy is most common in women of reproductive age who present with abdominal pain and vaginal bleeding approximately seven weeks after amenorrhea. Differential diagnosis of 1st trimester abdominal pain. Diagnosis and management of ectopic pregnancy the bmj. A leaflet is available free of charge from the ectopic pregnancy trust. Diagnosis and management of ectopic pregnancy american. Several factors are responsible for this, including misdiagnosis and failure to institute timely. Ectopic pregnancy is usually diagnosed in the first trimester of pregnancy. The estimated prevalence of ectopic pregnancy is 12% worldwide. In current practice, in developed countries, diagnosis relies on a combination of ultrasound scanning and serial serum betahuman chorionic gonadotrophin.
Pdf overview an ectopic pregnancy occurs when a fertilised ovum implants outside the normal uterine cavity. Ectopic pregnancy, an important cause of maternal morbidity and mortality, is estimated to occur in approximately 12% of pregnancies worldwide 1,2. Patients may be asymptomatic, hemodynamically compromised, or somewhere in between. Small studies have proposed that the success rates for medical management of ectopic pregnancy with single and multidose are comparable 30,31. However, small studies are underpowered and often lead to a type 2 error. Review open access incidence, diagnosis and management of tubal and nontubal ectopic pregnancies. Recent advances in diagnosis and treatment have led to a 50% reduction in. In the united kingdom nearly 12 000 ectopic pregnancies are diagnosed each year, which gives a prevalence of 1.
The etiology of ep concentrated mainly on factor causes delayed transport of the fertilized ovum through the fallopian tube favors implantation in tubal mucosa, thus giving rise to ep. Diagnosis and management of ectopic pregnancy 2016 bjog. The diagnosis of an ectopic pregnancy is usually a surprise and is often emotionally traumatic. When a pregnant patient presents with firsttrimester bleeding or. Diagnosis and management of ectopic pregnancy ncbi. An ectopic pregnancy ep falls within the area of the gynecological emergency andor reproductive management of women, which is the implantation of fertilized ovum outside the endometrial cavity. Ectopic pregnancy modern diagnosis and management is a comprehensive book which guides the reader through all features of ectopic pregnancy, both practical and academic, covering all aspects of diagnosis and management of ectopic pregnancy in a clear, concise, and practical fashion. This guidance has been updated and replaced by nice guideline ng126. Diagnosis and management of ectopic pregnancy greentop. Management of nontubal ectopic pregnancies may involve medical or surgical treatment, or a combination, as dictated by ectopic pregnancy location and the patients clinical stability. Pdf the diagnosis and management of ectopic pregnancy. A fertilized ovum implanting and maturing outside of the uterine endometrial cavity, with the most common site being the fallopian tube 97%, followed by the ovary 3. An early ectopic pregnancy without unstable bleeding is most often treated with a medication called methotrexate, which stops cell growth and dissolves existing cells. Ectopic pregnancy is any pregnancy that occurs outside the uterine cav ity.
Diagnosis and management of ectopic pregnancy bmj sexual. Pregnancies in the fallopian tube account for 97 percent of ecto. 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. Intramural pregnancy is a rare form of ectopic pregnancy, and little is known about its etiology, prevalence and natural history.
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