Ectopic pregnancy: a review

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This review discusses ectopic pregnancy risk factors, diagnostic methods, and treatment options, concluding that further research is needed for earlier detection despite decreased surgical intervention rates.

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This paper is a narrative review of ectopic pregnancy (EP), describing its epidemiology, maternal risk factors, diagnostic approaches (including β-hCG/progesterone and imaging such as transvaginal ultrasound, CT, and hysterosalpingography), and treatment strategies (surgical options, systemic/local medical therapy such as methotrexate, and expectant management). It reports that while review data suggest fewer surgical treatments over time, this does not necessarily indicate a true decline in EP occurrence, and it highlights the need for improved early detection. The paper’s stated limitation is that the conclusions are based on aggregated review data rather than evidence of changing disease incidence. Relevance to endometriosis: endometriosis is listed as an EP risk factor alongside pelvic inflammatory disease, Chlamydia trachomatis infection, smoking, tubal surgery, and induced conception cycles, though the paper’s main focus is EP epidemiology, diagnosis, and management rather than endometriosis itself.

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Abstract

PurposeEctopic pregnancy (EP) presents a major health problem for women of child-bearing age. EP refers to the pregnancy occurring outside the uterine cavity that constitutes 1.2-1.4 % of all reported pregnancies. All identified risk factors are maternal: pelvic inflammatory disease, Chlamydia trachomatis infection, smoking, tubal surgery, induced conception cycle, and endometriosis. These developments have provided the atmosphere for trials using methotrexate as a non-surgical treatment for EP. The diagnosis measure of EP is serum human chorionic gonadotropin, urinary hCGRP/i-hCG, progesterone measurement, transvaginal ultrasound scan, computed tomography, vascular endothelial growth factor, CK, disintegrin and metalloprotease-12 and hysterosalpingography. The treatment option of EP involves surgical treatment by laparotomy or laparoscopy, medical treatment is usually systemic or through local route, or by expectant treatment.ResultsIt was concluded that review data reflect a decrease in surgical treatment and not an actual decline in EP occurrence so that further new avenues are needed to explore early detection of the EP.
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Abstract

Purpose Ectopic pregnancy (EP) presents a major health problem for women of child-bearing age. EP refers to the pregnancy occurring outside the uterine cavity that constitutes 1.2–1.4 % of all reported pregnancies. All identified risk factors are maternal: pelvic inflammatory disease, Chlamydia trachomatis infection, smoking, tubal surgery, induced conception cycle, and endometriosis. These developments have provided the atmosphere for trials using methotrexate as a non-surgical treatment for EP. The diagnosis measure of EP is serum human chorionic gonadotropin, urinary hCGRP/i-hCG, progesterone measurement, transvaginal ultrasound scan, computed tomography, vascular endothelial growth factor, CK, disintegrin and metalloprotease-12 and hysterosalpingography. The treatment option of EP involves surgical treatment by laparotomy or laparoscopy, medical treatment is usually systemic or through local route, or by expectant treatment.

Results

It was concluded that review data reflect a decrease in surgical treatment and not an actual decline in EP occurrence so that further new avenues are needed to explore early detection of the EP. Similar content being viewed by others Abbreviations - EP: - Ectopic pregnancy - CEP: - Cervical ectopic pregnancy - OEP: - Ovarian ectopic pregnancy - CSEP: - Cesarean scar ectopic pregnancy - IP: - Interstitial pregnancy - PID: - Pelvic inflammatory disease - PROKR: - Prokineticin receptor - IVF: - In vitro fertilization - ART: - Assisted reproductive technology - β-hCG: - Serum human chorionic gonadotropin - TVS: - Transvaginal ultrasound scan - CT: - Computed tomography - VEGF: - Vascular endothelial growth factor - ADAM-12: - Disintegrin and metalloprotease-12 - Hsg: - Hysterosalpingography - MTX: - Methotrexate - PPV: - Positive predictive value

References

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Obstet Gynecol 89:118–122 Seifer DB (1997) Persistent ectopic pregnancy: an argument for heightened vigilance and patient compliance. Fertil Steril 68:402–404 Conflict of interest None declared. Author information Authors and Affiliations Corresponding authors Rights and permissions About this article Cite this article Rana, P., Kazmi, I., Singh, R. et al. Ectopic pregnancy: a review. Arch Gynecol Obstet 288, 747–757 (2013). https://doi.org/10.1007/s00404-013-2929-2 Received: Accepted: Published: Issue date: DOI: https://doi.org/10.1007/s00404-013-2929-2

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Pregnancy, Ectopic Pregnancy, Ectopic Pregnancy, Ectopic Pregnancy, Ectopic Abortifacient Agents, Nonsteroidal Abortifacient Agents, Nonsteroidal Female Humans Laparoscopy Methotrexate Methotrexate Pregnancy Risk Factors Salpingectomy Salpingostomy Watchful Waiting

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