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Ectopic Pregnancy

Jeremy Golding, MD, FAAFP Reviewed 06/2019
 


BASICS

DESCRIPTION

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

  • Abdominal: pregnancy implanted intra-abdomin...

DIAGNOSIS

HISTORY

In >50% of presenting cases, patients have sudden-onset abdominal pain coupled with cessation of/or irregular menses and acute vaginal bleeding (the classic triad). Other common sy...

TREATMENT

MEDICATION

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

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Patient Monitoring

  • Serial serum quantitative hCG until level drops to zero:

    • After methotrexate administration, a strict monitoring protocol should be followed .

    • Foll...

REFERENCES

1
Connolly A, Ryan DH, Stuebe AM, et al. Reevaluation of discriminatory and threshold levels for serum β-hCG in early pregnancy. Obstet Gynecol.  2013;121(1):65–70. [View Abstract on Ov...

ADDITIONAL READING

Barnhart KT. Clinical practice. Ectopic pregnancy. N Engl J Med.  2009;361(4):379–387. [View Abstract on OvidMedline] 

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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