Ectopic pregnancy

Ectopic pregnancy (EP) occurs in 1–2% of pregnancies, and is associated with significant morbidity and mortality. Women with abdominal pain or vaginal bleeding in early pregnancy, or risk factors for EP, are generally assessed by Early Pregnancy Assessment Units. Diagnosis is predominantly by trans-vaginal ultrasound supported by quantified serum human chorionic gonadotrophin (hCG). The resolution limit of trans-vaginal ultrasound means not all EPs can be identified, leaving women with a ‘Pregnancy of Unknown Location’. Management for EP has moved away from surgery with growing experience in medical management, and evidence-based recognition of expectant management for selected women. Surgery will always have a role in the management of women with EP who are acutely unwell, when medical management is not likely to work, or has failed. On-going areas of research include improvements in women's risk stratification at their first attendance with symptoms, shortening time until diagnosis of EP, and combination medical treatments.