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.
- 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.