Ectopic pregnancy is a complication of pregnancy in which the embryo attaches outside the uterus, most commonly in the fallopian tube. This condition is a significant cause of maternal morbidity and mortality, particularly in the first trimester.

Signs and Symptoms

Ectopic pregnancy can present with a variety of symptoms, making diagnosis challenging. Classic symptoms include abdominal pain and vaginal bleeding, though fewer than 50% of affected women experience both. The pain may be sharp, dull, or crampy and can spread to the shoulder if bleeding into the abdomen has occurred. Severe bleeding may lead to a fast heart rate, fainting, or shock.

Risk Factors

Risk factors for ectopic pregnancy include pelvic inflammatory disease (often due to chlamydia infection), tobacco smoking, endometriosis, prior tubal surgery, a history of infertility, and the use of assisted reproductive technology. Previous ectopic pregnancy significantly increases the risk of recurrence.

Diagnosis

Transvaginal Ultrasonography

Transvaginal ultrasonography is the primary diagnostic tool, with a sensitivity of at least 90%. An adnexal mass separate from the ovary is a key indicator of ectopic pregnancy.

hCG Levels

Measuring β-human chorionic gonadotropin (β-hCG) levels aids in diagnosis. An empty uterus with β-hCG levels higher than 1500 mIU/mL is suggestive of an ectopic pregnancy.

Treatment

Medical Treatment

Early ectopic pregnancies can be treated with methotrexate, which inhibits cell division in the developing embryo. This method is effective when the β-hCG is low, and the ectopic mass is small.

Surgical Treatment

Surgical options include salpingostomy (removal of the pregnancy while preserving the fallopian tube) or salpingectomy (removal of the affected tube). Surgery is necessary if the tube has ruptured, there is a foetal heartbeat, or the patient's essential signs are unstable.

Prognosis

The prognosis for the mother is generally good if the ectopic pregnancy is treated promptly. However, all foetuses in ectopic pregnancies do not survive. The risk of recurrence in future pregnancies is approximately 10%.

Epidemiology

Ectopic pregnancies account for about 1-2% of all pregnancies in developed countries. The incidence is higher among those using assisted reproductive technology.

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Self-assessment MCQs (single best answer)

Which of the following is the most common location for an ectopic pregnancy?

Which symptom is NOT typically associated with ectopic pregnancy?

Which diagnostic tool has a sensitivity of at least 90% for detecting ectopic pregnancy?

What does an adnexal mass separate from the ovary indicate in the context of ectopic pregnancy?

Which of the following is a risk factor for ectopic pregnancy?

At what β-hCG level is an empty uterus suggestive of an ectopic pregnancy?

Which medication is used in the medical treatment of early ectopic pregnancy?

Which surgical procedure involves the removal of the ectopic pregnancy while preserving the fallopian tube?

What is the approximate risk of recurrence of ectopic pregnancy in future pregnancies?

What percentage of pregnancies are ectopic in developed countries?