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Review
. 2015 Oct 9;112(41):693-703; quiz 704-5.
doi: 10.3238/arztebl.2015.0693.

The Diagnosis and Treatment of Ectopic Pregnancy

Florin-Andrei Taran  1 , Karl-Oliver Kagan, Markus Hübner, Markus Hoopmann, Diethelm Wallwiener, Sara Brucker
Affiliations
Review

The Diagnosis and Treatment of Ectopic Pregnancy

Florin-Andrei Taran et al. Dtsch Arztebl Int. .

Abstract

Background: Extrauterine pregnancy is a complication of the first trimester of pregnancy that arises in 1.3-2.4% of all pregnancies.

Methods: This review is based on articles and guidelines retrieved by a selective PubMed search.

Results: The presentation of extrauterine pregnancy is highly variable, ranging from an asymptomatic state, to pelvic pain that is worse on one side, to tubal rupture with hemorrhagic shock. 75% of tubal pre gnancies can be detected by transvaginal ultrasonography. In patients with a vital extrauterine pregnancy, the human chorionic gonadotropin concentration generally doubles within 48 hours. Laparoscopy is the gold standard of treatment. Two randomized, controlled trials comparing organ-preserving treatment with ablative surgery revealed no significant difference in pregnancy rates after the intervention, but precise details of the surgical procedures were not provided, and long-term fertility data are lacking. Metho - trexate therapy should be used only for strict indications.

Conclusion: Further randomized, controlled trials with longer follow-up will be needed to answer currently open questions about the potential for individualized surgical treatment and the proper role of pharmacotherapy.

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Figures

Figure 1
Figure 1
Right tubal pregnancy in week 6 + 5 of gestation.
Figure 2
Figure 2
Ultrasonographic findings in four different cases of tubal pregnancy. a) Right tubal pregnancy in week 6 + 1 of gestation, with blob sign and circular Doppler ultrasonographic signal. b) Vital left tubal pregnancy in week 6 + 0 of gestation, with a yolk sac and an embryo measuring 2 mm (crown-rump) with detectable cardiac activity (shown in 3D-VCI mode) c) Right tubal pregnancy in week 5 + 3 of gestation, with bagel sign; note the difference in echogenicity compared to the cystic corpus luteum. d) Right tubal pregnancy within a hematosalpinx; abundant free fluid indicating hematoperitoneum.
Figure 3
Figure 3
Algorithm for the individualized surgical treatment of tubal pregnancy (TP), modified from Wallwiener et al. (28)
Figure 4
Figure 4
a) Right ovarian pregnancy, week 6 + 4 of gestation; b) interstitial pregnancy in the left tubal angle in week 7 + 3 of gestation.
See this image and copyright information in PMC

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