Ectopic pregnancy--risk factors and diagnosis

Abstract

Background: Ectopic pregnancy is still the most common cause of first trimester maternal deaths, accounting for 73% of early pregnancy mortalities.

Objective: Detailed management will not be discussed in this review. However, risk factors for tubal ectopic pregnancy, ultrasound diagnosis and the benefits of early pregnancy units will be discussed.

Discussion: All women in the reproductive age group who present to a general practitioner or hospital emergency department with lower abdominal pain, with or without vaginal bleeding, have an ectopic pregnancy until proven otherwise. A urinary pregnancy test is mandatory in this clinical situation and if positive, these women should then have a transvaginal--not transabdominal--ultrasound scan (TVS) performed. The diagnosis of ectopic pregnancy should be based on the positive visualisation of an adnexal mass using TVS rather than on the basis of a scan that fails to demonstrate an intrauterine gestational sac. Diagnosing the condition earlier in its natural history using TVS has changed management options and reduced the associated mortality, with collapse and subsequent emergency laparotomy being the exception rather than the rule in modern practice. Early pregnancy units have been shown to benefit women with early pregnancy complications, reduce unnecessary admissions, reduce costs and are an effective use of resources.