Ectopic Pregnancy

Ryan J. Callery, MD Reviewed 06/2017
 


BASICS

DESCRIPTION

Ectopic: pregnancy implanted outside the confines of the uterine cavity. Subtypes include: 
  • Tubal: pregnancy implanted in any portion of the fallopian tube

  • Abdominal: pregnancy implant...

DIAGNOSIS

HISTORY

In >50% of presenting cases, patients have sudden-onset abdominal pain coupled with cessation of/or irregular menses. Other common symptoms include nausea and/or vomiting, vaginal ...

TREATMENT

MEDICATION

  • Methotrexate (MTX): treatment for unruptured tubal pregnancy or for remaining POCs after laparoscopic salpingostomy. MTX inhibits DNA synthesis via folic acid antagonism by inactiv...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Patient Monitoring

  • Serial serum quantitative hCG until level drops to zero:

    • ▪ After MTX administration, a strict monitoring protocol should be followed 4.
    • ▪ Followin...

REFERENCES

Verhaegen  J, Gallos  ID, van Mello  NM, et al. Accuracy of single progesterone test to predict early pregnancy outcome in women with pain or bleeding: meta-analysis of cohort studies. BMJ...

ADDITIONAL READING

  • Barnhart KT. Clinical practice. Ectopic pregnancy. N Engl J Med.  2009;361(4):379–387.

  • Hajenius PJ, Mol F, Mol BW, et al. Interventions for tubal ectopic pregnancy. Cochrane D...

CODES

ICD10

  • O00.9 Ectopic pregnancy, unspecified

  • O00.1 Tubal pregnancy

  • O00.0 Abdominal pregnancy

  • O00.2 Ovarian pregnancy

  • O00.8 Other ectopic pregnancy

ICD9

  • 633.90 Unspecified ectopic pregnancy without intrau...

CLINICAL PEARLS

  • Ectopic pregnancy is the leading cause of 1st trimester maternal death and accounts for 6% of U.S. pregnancy deaths.

  • 97% of ectopic pregnancies occur in the fallopian tube.

  • Diagnosis req...

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