Most ectopic pregnancies implant in the ampulla of the fallopian tube, implantation occasionally occur at the cornua (interstitial ectopic pregnancies).
| Risk factors | • Previous ectopic pregnancy • Previous pelvic/tubal surgery • Pelvic inflammatory disease | | --- | --- | | Clinical features | • Abdominal pain, amenorrhea, vaginal bleeding • Hypovolemic shock in ruptured ectopic pregnancy • Cervical motion, adnexal &/or abdominal tenderness • ± Palpable adnexal mass | | Diagnosis | • Positive hCG • TVUS revealing adnexal mass, empty uterus thin endometrium and a pregnancy outside the uterine cavity | | Management | • Stable: methotrexate • Unstable: surgery |
Patients may be asymptomatic or have normal symptoms of pregnancy (eg, nausea/vomiting, breast tenderness).
potentially life-threatening condition due the high risk of fallopian tube rupture and hemorrhage
Management of ectopic pregnancy is either medical (ie, methotrexate) or surgical, depending on maternal hemodynamic status and ability to tolerate methotrexate therapy
Methotrexate is typically used in patients with an unruptured ectopic pregnancy. Diagnostic laparoscopy is performed in patients with hemodynamic instability (ie, ruptured ectopic pregnancy) or patients with contraindications to methotrexate (eg, immunodeficiency, breastfeeding).
Methotrexate is the medical therapy for ectopic pregnancies in patients with hemodynamic stability; no renal, hepatic, or hematologic disorders (due to drug toxicity); and low β-hCG level (ie, <5000 mIU/mL). Methotrexate is a folate antagonist that inhibits DNA synthesis and cell growth preferentially in rapidly dividing cells (eg, trophoblasts). After treatment, patients require monitoring of β-hCG levels until they become undetectable to ensure that treatment is complete.
