section name header

Info


A. Epidemiology navigator

  1. Rate is nearly 2% of pregnancies in USA
  2. Second major cause of maternal mortality in USA
  3. Major cause of maternal mortality in first trimester

B. Risk Factors navigator

  1. Usually occurs in women with impaired fallopian tube function
  2. High Risk (>5 fold increase)
    1. Tubule surgery
    2. Sterilization
    3. Previous Ectopic Pregnancy
    4. In utero exposure to diethylstilbestrol (DES)
    5. Use of intrauterine device (IUD) for contraception
  3. Moderate Risk (>2 fold increase)
    1. Infertility (including due to gynecologic infections)
    2. Previous gynecologic infections
    3. Multiple sex partners
  4. Somewhat Increased risk
    1. Smoking
    2. Pelvic Surgery
    3. Vaginal Douching

C. Symptoms and Signs navigator

  1. Abdominal Pain and/or Tenderness >75%
  2. Pelvic Pain and/or Flank Pain
    1. Isthmic ectopics present early
    2. However, ampullary ectopics present late
  3. Amenorrhea
  4. Pain radiating to shoulder
  5. Cervical motion tenderness ~67%
  6. Palpable adnexal mass ~50%
  7. Syncope
  8. Shock (usually following rupture)

D. Diagnosis [3]navigator

  1. High suspicion in all persons at moderate to high risk
  2. Screening by measuring ß-hCG with transvaginal ultrasound
    1. Sensitivity ~85%
    2. Specificity 100%
  3. ß-HCG (human chorionic gonadogropin)
    1. Note that in normal pregnancy, ß-hCG levels double every ~2 days
    2. If quantitative ß-hCG is >1500 then should see gestational sac on vaginal ultrasound
    3. If quantitative ß-hCG >5000 then should see sac on abdominal ultrasound
    4. Progesterone levels are useful as single measurement
    5. Progesterone level >25ng/mL excludes ectopic pregnancy by >97%
  4. Pelvic or transvaginal ultrasound
    1. Rule out intrauterine pregnancy
    2. Confirm diagnosis of ectopic pregnancy

E. Treatmentnavigator

  1. Medical and Surgical treatment modalities are available
  2. Surgical
    1. Laparoscopy is mainstay
    2. Oophorectomy / Salpingectomy
  3. Medical [3]
    1. Methotrexate 20mg single dose IM if stable with no acute abdomen
    2. About 20% of women will require additional cycle of methotrexate
    3. RU486 (Mifepristone) - close to approved in USA [2]

References navigator

  1. Pisarska MD, Carson SA, Buster JE. 1998. Lancet. 351(9109):1115 abstract
  2. Spitz IM, Bardin CW, Benoton L, Robbins A. 1998. NEJM. 338(18):1241 abstract
  3. Lipscomb GH, Stovall TG, Ling FW. 2000. NEJM. 343(18):1325 abstract