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Feature Article

Diagnosis and management of ectopic pregnancy

Iris Wang

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Abstract

Ectopic pregnancy remains the leading cause of maternal death in the first trimester. Its diagnosis presents challenges despite modern diagnostic tests and its treatment remains controversial to this day.

Key Points

  • The diagnosis and management of ectopic pregnancy still present challenges; ectopic pregnancy remains the leading cause of maternal death in the first trimester.
  • Bleeding in the first trimester of pregnancy is the most common symptom of ectopic pregnancy; however, it is also a common symptom in the first trimester of a viable ongoing intrauterine pregnancy.
  • Generally, an intrauterine sac is visible by seven weeks’ gestation. The presence of an empty uterus and a positive beta-human chorionic gonadotrophin (HCG) result are the hallmarks of an ectopic pregnancy.
  • Beta-HCG levels rise by 50% every 48 hours in a successful intrauterine pregnancy. The plateau or very slow change of beta-HCG levels is highly suggestive of an ectopic pregnancy.
  • If an ectopic pregnancy is not ruptured, the ectopic tissue is not more than 4 cm in size and there is no positive fetal heart beat, laparoscopic salpingostomy is a good treatment choice when risk and benefit profiles are considered.
  • In women treated with conservative surgery (salpingostomy) or methotrexate injection it is vital to follow up beta-HCG until levels are less than 2 IU/L.

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