Diagnosis and treatment of ectopic pregnancy

Abstract

Ectopic pregnancy is a life- and fertility-threatening condition that is commonly seen in Canadian emergency departments. Increases in the availability and use of hormonal markers, coupled with advances in formal and emergency ultrasonography have changed the diagnostic approach to the patient in the emergency department with first-trimester bleeding or pain. Ultrasonography should be the initial investigation for symptomatic women in their first trimester; when the results are indeterminate, the serum beta human chorionic gonadotropin (beta-hCG) concentration should be measured. Serial measurement of beta-hCG and progesterone concentrations may be useful when the diagnosis remains unclear. Advances in surgical and medical therapy for ectopic pregnancy have allowed the proliferation of minimally invasive or noninvasive treatment. Guidelines for laparoscopy and for methotrexate therapy are provided.

Fig. 1: Transvaginal ultrasound image, showing intrauterine fluid collection without yolk sac or fetal pole: “pseudogestational sac” (arrow).

Fig. 2: Transvaginal ultrasound image, showing early intrauterine gestational sac (GS) with yolk sac (YS).

Fig. 3: Transvaginal ultrasound image, showing empty uterus and complex adnexal mass (ectopic pregnancy [EP]) separate from ovary.

Fig. 4: Recommended approach to investigating first-trimester pain or bleeding in the hemodynamically stable patient in the emergency department (ED). β-hCG = β human chorionic gonadotropin, US = ultrasonography, IUP = intrauterine pregnancy, EP = ectopic pregnancy.

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