Ectopic pregnancy

Ectopic pregnancy is a implantation occurring elsewhere than in the cavity of the uterus, whereas ninty-nine percent of extrauterine pregnancies occur in the fallopian tube. The incidence of extrauterine pregnancy has increas ed from 0.5% thirty years ago, to a present day 1-2%. The most frequent cau se of tubal pregnancy is previous salpingitis. Mortality rates for tubal pr egnancies used to be approximately 1.7% in the 1970 s but dropped to 0.3% i n 1980 s. Diagnosis. Using transvaginal ultrasound it is possible to obtain positive evidence of an ectopic pregnancy at a very early stage. In cases of hCG titers>2000 IU/l, intrauterine pregnancy can be diagnosed with certa inty. The most important differential diagnosis of ectopic pregnancy is ear ly intrauterine pregnancy. Clinical management and therapy: Regardless of t he therapeutic strategy selected by the physician, informing the patient is a major aspect of the management of ectopic pregnancy. If surgery is consi dered appropriate, the patient must be informed about the nature, side effe cts and complications of the procedure. However, it should be remembered th at in some cases, the actual chances of cure first become apparent at surge ry. In asymptomatic patients with a serum hCG titer <1000 IU/l that is fall ing, it is appropriate to wait and watch. In clinically stable patients wit h an unruptured tubal pregnancy and steady hCG levels, systemic treatment w ith methotrexate might also be considered. In unruptured tubal pregnancy wi th a hCG titer between 1000 and 2500, a further therapeutic alternative is intratubal injection of prostaglandins, hyperosmolar glucose of NaCl. Gener ally speaking, the currently widespread laparoscopic surgical treatment of the fallopian tube hardly influences the risk of recurrence. If the gestati onal mass is larger, the serum hCG titer higher than the approximate limit of 2500 mU/ml and/or the tube already ruptured, surgery is usually required . Prevention: The most effective prevention is to avoid tubal inflammation or, in cases of preexisting inflammation, to administer effective therapy.