Management of ectopic pregnancy: a clinical approach

Ectopic pregnancy is a common problem and one that is expected to increase in parallel with higher rates of sexually-transmitted disease and the increased availability and use of assisted conception. Continued improvements in ultrasound and its application, together with rapid access to serum human chorionic gonadotrophin (hCG) monitoring, have increased the accuracy of diagnosis and may have contributed to an apparently increased incidence, although the number of ectopic pregnancies appears relatively stable over the past 10–15 years. Laparoscopic surgery, rather than open surgery, is now the main method of treatment, although the medical treatment of ectopic pregnancy through the administration of methotrexate is popular in a number of centres. However, whilst the methods used for the diagnosis and management of ectopic pregnancy have changed significantly over the past 20 years, the death rate remains largely unchanged. This partly relates to substandard care, but also reflects the speed at which complications can occur and how rapidly a patient can deteriorate.