Management of Ectopic Pregnancy

Abstract

A reproductive age female presenting with pelvic pain, a positive urine pregnancy test, and an inconclusive pelvic ultrasound provokes diagnostic uncertainty and anxiety for the practicing physician. The spectrum of diagnostic possibilities ranges from a symptomatic but normally implanted pregnancy to an ectopic pregnancy implanted in the uterine tube or elsewhere outside of the uterus. While management of the patient with acute symptoms clearly calls for urgent surgical intervention, management of the asymptomatic patient whose implantation site is indeterminate requires patient follow-up with serial serum HCG levels, periodic ultrasound imaging, and repeat physical examinations. The clinician must cope with the risk of possible rupture of an ectopic pregnancy and its associated morbidities. Pregnancy of unknown location accounts for 1–2% of all gestations and 4–6% of pregnancy-related deaths worldwide [1]. This chapter will describe a current approach to the diagnosis and management of ectopic pregnancy.