Management of ectopic pregnancy depends primarily on patient stability
Stable
• Pregnancy can't be identified on US
• β-hCG titer < 1500-2000 mIU
Unstable
• Pregnancy can be identified on US
• β-hCG titer > 1500-2000 mIU
• Hypotension
• Tachycardia
• Peritoneal irritation
Unruptured ectopic
Ruptured ectopic
Possible ectopic
Expectanat managment
Further blood test taken 48 hours
later:
1. In viable IUP, β-hCG double
every 48 hours.
2. In miscarriage, β-hCG expected
to halve every 48 hours.
3. In ectopic pregnancy, β-hCG
increase or drop slightly outside
these limits.
• β-hCG titer < 6000 mIU
• Gestational sac size < 3.5 cm
• Absence of fetal heart motion
• β-hCG titer > 6000 mIU
• Gestational sac size ≥ 3.5 cm
• Fetal heart motion is seen
Early ectopic
Late ectopic
Medical managment
Surgical managment
• IM Methotrexate single dose
(1mg/kg) (folic acid antagonist inhibits
DNA synthesis).
• Patients should be followed up with
β-hCG titer to ensure her response to
therapy and a second dose is
prescribed only if β-hCG level doesn’t
fall adequately.
• When medical management failed
surgical management should be done.
• "Laparoscopy" is commonly used
but "Laparotomy" is preferred for
hemodynamecally unstable patient to
arrest the bleeding, and for patient
with multiple surgeries and
adhesions.
• Surgery performed depends on the
amount of tubal damage and the
patient's wishes for furure fertility:
1. Complete salpingectomy
(removal of the entire fallopian
tube)
2.
3.
4.
Partial salpingectomy
(removal of a portion of the
fallopian tube)
Salpingotomy (closed incision
made through the anumesentiric
border of the fallopian tube to
remove the POC)
Salpingostomy (open incision
made through the anumesentiric
border of the fallopian tube to
remove the POC)
• Patients who don’t have
salpingectomy should followed up
with β-hCG titer 3-7 days post-op to
confirm that no β-hCG producing
cells remain to reinvade the tube.
ABCDE approach should
be used to stabilize the
patient first