Ectopic pregnancy: an update
- 1 August 2004
- journal article
- review article
- Published by Ovid Technologies (Wolters Kluwer Health) in Current Opinion in Obstetrics and Gynecology
- Vol. 16 (4), 289-293
- https://doi.org/10.1097/01.gco.0000136494.49334.6b
Abstract
This review discusses recent publications that investigate the epidemiology, diagnosis and treatment of ectopic pregnancy. Transvaginal ultrasound is being used with increasing confidence for the diagnosis of ectopic pregnancy, and methotrexate now has an established role in the treatment of ectopic pregnancy. No serum markers have been found that can reliably differentiate intrauterine from extrauterine pregnancy. As more experience has been gained with medical therapy, it is apparent that it is possible to identify a subgroup of women in whom it is unlikely to succeed. The use of adjunctive therapy such as mifepristone does not appear to increase the effectiveness of methotrexate. Screening for ectopic pregnancy in at-risk women has been suggested, but it may be of only limited value. In the surgical management of ectopic pregnancy the effect on fertility of salpingotomy and salpingectomy remains uncertain, although recent cohort studies suggest that salpingotomy may be associated with a better subsequent intrauterine pregnancy rate than salpingectomy. A number of case reports of pregnancies at unusual sites continue to be published, but in the last 2 years there has been a dramatic increase in the number of caesarean scar pregnancies reported. Medical therapy now has an established role in the treatment of ectopic pregnancy, but it is clear that careful patient selection is essential. In the surgical management of ectopic pregnancy the effects of salpingotomy and salpingectomy on subsequent fertility are uncertain and need further investigation.Keywords
This publication has 33 references indexed in Scilit:
- Three-dimensional transvaginal sonography of interstitial pregnancyJournal of Clinical Ultrasound, 2003
- OC198: Should an ectopic pregnancy always be diagnosed using transvaginal ultrasonography in the first trimester prior to surgery?Ultrasound in Obstetrics & Gynecology, 2003
- OC019: The efficacy of ultrasound-based protocol for the diagnosis of tubal ectopic pregnancyUltrasound in Obstetrics & Gynecology, 2003
- Glycodelin serum levels in women with ectopic pregnancyEuropean Journal of Obstetrics & Gynecology and Reproductive Biology, 2003
- Effect of transvaginal sonography on the use of invasive procedures for evaluating patients with a clinical diagnosis of ectopic pregnancyJournal of Clinical Ultrasound, 2002
- Surveillance in a Time of Changing Health Care Practices: Estimating Ectopic Pregnancy Incidence in the United StatesMaternal and Child Health Journal, 2002
- Evaluation of leukemia inhibitory factor as a marker of ectopic pregnancyAmerican Journal of Obstetrics and Gynecology, 2001
- Serum levels of smooth muscle heavy-chain myosin in patients with ectopic pregnancyAnnals of Emergency Medicine, 2000
- Fetal fibronectin as a marker to discriminate between ectopic and intrauterine pregnanciesAmerican Journal of Obstetrics and Gynecology, 1998
- Maternal serum creatine kinase: A possible predictor of tubal pregnancyAmerican Journal of Obstetrics and Gynecology, 1993