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Diagnosis and management of ectopic pregnancy
  1. Vanitha N Sivalingam1,
  2. W Colin Duncan2,
  3. Emma Kirk3,
  4. Lucy A Shephard4,
  5. Andrew W Horne5
  1. 1Specialist Registrar in Obstetrics and Gynaecology, Simpson Centre for Reproductive Health, Royal Infirmary of Edinburgh, Edinburgh, UK
  2. 2Senior Lecturer and Consultant in Reproductive Medicine, MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
  3. 3Specialist Registrar in Obstetrics and Gynaecology, Department of Obstetrics and Gynaecology, North Middlesex University Hospital, London, UK
  4. 4Reproductive Biology Honours Student, MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
  5. 5MRC Clinician Scientist and Consultant Gynaecologist, MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
  1. Correspondence to Dr Andrew W Horne, MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, UK; andrew.horne{at}ed.ac.uk

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Overview

An ectopic pregnancy occurs when a fertilised ovum implants outside the normal uterine cavity.1,,3 It is a common cause of morbidity and occasionally of mortality in women of reproductive age. The aetiology of ectopic pregnancy remains uncertain although a number of risk factors have been identified.4 Its diagnosis can be difficult. In current practice, in developed countries, diagnosis relies on a combination of ultrasound scanning and serial serum beta-human chorionic gonadotrophin (β-hCG) measurements.5 Ectopic pregnancy is one of the few medical conditions that can be managed expectantly, medically or surgically.1 3 6

Incidence

In the developed world, between 1% and 2% of all reported pregnancies are ectopic pregnancies (comparable to the incidence of spontaneous twin pregnancy).7 The incidence is thought to be higher in developing countries, but specific numbers are unknown. Although the incidence in the developed world has remained relatively static in recent years, between 1972 and 1992 there was an estimated six-fold rise in the incidence of ectopic pregnancy.8 This increase was attributed to three factors: an increase in risk factors such as pelvic inflammatory disease and smoking in women of reproductive age, the increased use of assisted reproductive technology (ART) and increased awareness of the condition, facilitated by the development of specialised early pregnancy units (EPUs).

Morbidity and mortality

In the UK, ectopic pregnancy remains the leading cause of pregnancy-related first trimester death (0.35/1000 ectopic pregnancies).3 6 9 However, in the developing world it has been estimated that 10% of women admitted to hospital with a diagnosis of ectopic pregnancy ultimately die from the condition.10 Ectopic pregnancy is a considerable cause of maternal morbidity, causing acute symptoms such as pelvic pain and vaginal bleeding and long-term problems such as infertility.3 Short- and long-term consequences of ectopic pregnancy on …

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