Ectopic Pregnancy
Ruptured ectopic pregnancy is a surgical emergency, but there are two other tubal pregnancy scenarios
that are amenable to less aggressive treatment for the patient who is hemodynamically stable and has
limited intraperitoneal blood loss, tubal abortion and unruptured ectopic pregnancy. A tubal abortion
results when the pregnancy is extruded from the fimbriated end of the tube. Pain is often described as
lateralized cramping, and the volume of blood identified in the cul-de-sac is approximately 100 mL. These
events may be self-limited and, if pain and hemodynamic status are under control during observation,
surgery may be avoided.
A patient may present with pain and vaginal bleeding; an intact tubal pregnancy is identified by
ultrasound. There are varying sets of criteria for medical management of the unruptured tubal pregnancy,
based on gestational size (<3 to 5 cm) and the presence of fetal cardiac activity, but the physician must
actively consider medical rather than surgical management.[4]
Surgical procedures for managing an ectopic pregnancy include salpingectomy, salpingostomy, and
segmental resection.[5] For the patient desiring to maintain maximal future fertility, preservation of the tube
is preferable.
The medical treatment of tubal pregnancy relies on the cytotoxic effect of methotrexate. There are several
protocols for dosage (e.g., 1 mg/kg) and follow-up. Consultation with an experienced gynecologist before
initiation is advisable.
Copyright © 2013 Elsevier Inc. All rights reserved. Read our Terms and Conditions of Use and our Privacy Policy.
For problems or suggestions concerning this service, please contact: online.help@elsevier.com