Tubal ectopic pregnancy

Tubal ectopic pregnancy is a potentially life-threatening condition; management depends on the risk of tubal rupture.

Risk of tubal ectopic pregnancy increases with previous ectopic pregnancy, previous damage to the fallopian tubes (e.g., previous tubal surgery, in utero diethylstilbestrol exposure of the mother), ascending pelvic infections (e.g., pelvic inflammatory disease, chlamydia, gonorrhea, salpingitis), history of infertility or assisted conception, intrauterine device use at the point of conception, race/ethnicity, age <18 years at first sexual encounter, maternal age >35 years, multiple sexual partners, and smoking.

Symptoms generally appear 6-8 weeks after the last normal menstrual period. Classic symptoms and signs are abdominal or pelvic pain, amenorrhea, and vaginal bleeding with or without clots. Hemodynamic instability, an acute abdomen, and cervical motion tenderness may indicate rupture or imminent rupture.

If the woman is hemodynamically stable, transvaginal ultrasound is the initial test of choice.

Treatment approaches for tubal ectopic pregnancy include expectant, medical (methotrexate), or surgical (salpingectomy or salpingostomy) management.

If an ectopic pregnancy ruptures, the woman may present in shock from blood loss and with unusual patterns of referred pain from intraperitoneal blood.

An ectopic pregnancy occurs if a fertilized ovum implants and matures outside the uterine endometrial cavity, with the most common site being the fallopian tube (97%), followed by the ovary (3.2%) and the abdomen (1.3%).[1]Bouyer J, Coste J, Fernandez H, et al. Sites of ectopic pregnancy: a 10 year population-based study of 1800 cases. Hum Reprod. 2002 Dec;17(12):3224-30. https://academic.oup.com/humrep/article/17/12/3224/569616 http://www.ncbi.nlm.nih.gov/pubmed/12456628?tool=bestpractice.com If undiagnosed or untreated, it may lead to maternal death due to rupture of the implantation site and intraperitoneal hemorrhage.[2]Ankum WM, Mol BW, Van Der Veen F, et al. Risk factors for ectopic pregnancy: a meta-analysis. Fertil Steril. 1996 Jun;65(6):1093-9. http://www.ncbi.nlm.nih.gov/pubmed/8641479?tool=bestpractice.com

This topic discusses the diagnosis and management of tubal ectopic pregnancies, which form the majority of ectopic pregnancies. Diagnosis and management of nontubal ectopic pregnancies vary according to location and the need to preserve uterine health.