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Ectopic pregnancy is a potentially life-threatening condition in which the embryo implants outside the uterine cavity.

Incidence

The incidence of ectopic pregnancy has more than quadrupled in the USA. Currently, 20 cases occur per 1000 pregnancies.

Ectopic pregnancies account for 10% of pregnancy-related maternal deaths in th USA. Most are attributed to hemorrhage and are potentially preventable.

Risk Factors

· High risk : tubal corrctive surgery, tubal sterilization, previous ectopic pregnancy.

· Moderate risk : infertility, previous genital infection, multiple partners.

· Slight risk L previous pelvic or abdominal surgery, smoking, douaching, sexual intercourse before 18 years.

Signs and Symptoms

· Pain : remain the most common symptom. Most patients also report abnormal vaginal bleeding, usually spotting or slight intermittent bleeding.

· Patients with acute rupture present with sharp, tearing, pelvic pain associated with fainting.

· Tachycardia, hypotension and cervical motion tenderness.

Diagnosis

· A Thorough history and physical examination are essential. The extent should be dictated by the severity of symptoms at presentation.

· Serial quantitative levels of the β-hCG levels are important.

· Transvaginal ultrasonography can detect an intrauterine gestational sac.

Management

Medical Therapy

Metotrexate chemotherapy is effective treatment for select patient with small, unrupteured ectopic pregnancies. Metotreaxate (MTX) side effects (nausea, vomiting) are generally mild. Localized, mild abdominal pain is a common complaint following MTX due to serosal irritation. However, patients should be closely monitored since rupture is a known risk.

Surgical Therapy

· In a patient who is hemodynamically unstable due to rupture of the ectopic pregnancy, emergency surgery (usually laparatomy with or without removal of the rupture fallopian tube) remains the treatment of choice.

· In a hemodynamically stable patient with a ruptured tubal pregnancy, laparoscopy and either removaql (salpingectomy) or segmental resection of the tube may be necessary.

· In a hemodynamically stable patient with an unreuptured tubal pregnancy, conservative surgery with tubal salvage.

· Oophorectomy is only indicated to achieve hemostasis.

Evaluation strategies

· The history provieds a description of the nature, intensity, and distribution of the pain. However, imprecise localization is typical with intra-abdominal processes.

· The physical examination includes a comprehensive gynecologic examination. Specific attention should be paid to reproducing the pain symptoms.

· Culturesm serum chemistry and electrolyte evaluations, or ultrasonography and other imaging studies may be indicated.

· Specialized diagnostic studies based on the presumptive diagnosis may be require consultation with other specialist in anesthesiology, orthopedics, neurology or gastroenterology.