Ectopic pregnancy

Ectopic Pregnancy (EP) occurs in around 1-2% of all pregnancies, and is associated with significant morbidity and mortality. Over 98% implant in the Fallopian tube. Women with risk factors, or early pregnancy symptoms of abdominal pain or vaginal bleeding are assessed by Early Pregnancy Assessment Services. The mainstay of diagnosis is by transvaginal ultrasound supported by serial serum human chorionic gonadotrophin (hCG) measurements. Management of tubal EP has moved away from surgery with growing experience with medical (methotrexate) and expectant management for selected women. Surgery will always have a role in the management of women with EP who are acutely unwell, where medical management is not likely to work, and for failed medical management. Ultrasound diagnostic criteria for non-tubal EP have been established and these cases are best managed on an individual basis. Future areas for research are the need to shorten the time to diagnosis an EP and the use of novel combination medical treatments. Future areas of medical education are the critical need to teach healthcare professionals to consider pregnancy related causes of collapse in all women of reproductive age.