Incidence, Diagnosis and Management of Tubal and Nontubal Ectopic Pregnancies: a Review

Overview

Journal Fertil Res Pract

Publisher Biomed Central

Specialty Reproductive Medicine

Date 2017 Jun 17

PMID 28620520

Citations 62

Authors

Danielle M Panelli

Catherine H Phillips

Paula C Brady

Affiliations

Soon will be listed here.

Abstract

Background: Ectopic pregnancy is a potentially life-threatening condition occurring in 1-2 % of all pregnancies. The most common ectopic implantation site is the fallopian tube, though 10 % of ectopic pregnancies implant in the cervix, ovary, myometrium, interstitial portion of the fallopian tube, abdominal cavity or within a cesarean section scar.

Findings: Diagnosis involves a combination of clinical symptoms, serology, and ultrasound. Medical management is a safe and effective option in most clinically stable patients. Patients who have failed medical management, are ineligible, or present with ruptured ectopic pregnancy or heterotopic pregnancy are most often managed with excision by laparoscopy or, less commonly, laparotomy. Management of nontubal ectopic pregnancies may involve medical or surgical treatment, or a combination, as dictated by ectopic pregnancy location and the patient's clinical stability. Following tubal ectopic pregnancy, the rate of subsequent intrauterine pregnancy is high and independent of treatment modality.

Conclusion: This review describes the incidence, risk factors, diagnosis, and management of tubal and non-tubal ectopic and heterotopic pregnancies, and reviews the existing data regarding recurrence and future fertility.

Citing Articles

Two case reports of triple ectopic: Literature review of incidence, risk factors and management of recurrent ectopic pregnancy.

Bolaji I, Yandra A, Awoniyi M, Igbenehi C Ultrasound. 2024; :1742271X241299228.

PMID: 39678711 PMC: 11635797. DOI: 10.1177/1742271X241299228.

Pathology of the Salpinx: A Retrospective Literature Review.

Olonade I, Adegunle A, Kaza S Cureus. 2024; 16(8):e67624.

PMID: 39310518 PMC: 11416861. DOI: 10.7759/cureus.67624.

Challenging Diagnosis of Late Abdominal Pregnancy: A Case Study of Misdiagnosis and Fetal Death in the Third Trimester.

Alwafai Z, Kolbe C, Kruse-Wieczorek J, Khanji M, Zygmunt M Am J Case Rep. 2024; 25:e943625.

PMID: 38980831 PMC: 11318717. DOI: 10.12659/AJCR.943625.

A Systematic Review about Cervical Pregnancy and our Experience.

Nikolettos K, Oikonomou E, Kotanidou S, Kritsotaki N, Kyriakou D, Tsikouras P Acta Med Litu. 2024; 31(1):92-101.

PMID: 38978851 PMC: 11227684. DOI: 10.15388/Amed.2024.31.1.13.

Infertility and pregnancy outcomes among adults with primary ciliary dyskinesia.

Schreck L, Pedersen E, Dexter K, Manion M, Massin N, Maitre B Hum Reprod Open. 2024; 2024(3):hoae039.

PMID: 38962571 PMC: 11219480. DOI: 10.1093/hropen/hoae039.

References

Trojano G, Colafiglio G, Saliani N, Lanzillotti G, Cicinelli E . Successful management of a cervical twin pregnancy: neoadjuvant systemic methotrexate and prophylactic high cervical cerclage before curettage. Fertil Steril. 2008; 91(3):935.e17-9. DOI: 10.1016/j.fertnstert.2008.11.009. View

Mesogitis S, Pilalis A, Daskalakis G, Papantoniou N, Antsaklis A . Management of early viable cervical pregnancy. BJOG. 2005; 112(4):409-11. DOI: 10.1111/j.1471-0528.2004.00447.x. View

Takeda A, Koyama K, Imoto S, Mori M, Sakai K, Nakamura H . Successful management of interstitial pregnancy with fetal cardiac activity by laparoscopic-assisted cornual resection with preoperative transcatheter uterine artery embolization. Arch Gynecol Obstet. 2008; 280(2):305-8. DOI: 10.1007/s00404-008-0896-9. View

Clayton H, Schieve L, Peterson H, Jamieson D, Reynolds M, Wright V . Ectopic pregnancy risk with assisted reproductive technology procedures. Obstet Gynecol. 2006; 107(3):595-604. DOI: 10.1097/01.AOG.0000196503.78126.62. View

Pisarska M, Carson S . Incidence and risk factors for ectopic pregnancy. Clin Obstet Gynecol. 1999; 42(1):2-8; quiz 55-6. DOI: 10.1097/00003081-199903000-00004. View

Hung T, Shau W, Hsieh T, Hsu J, Soong Y, Jeng C . Prognostic factors for an unsatisfactory primary methotrexate treatment of cervical pregnancy: a quantitative review. Hum Reprod. 1998; 13(9):2636-42. DOI: 10.1093/humrep/13.9.2636. View

Zhang X, Liu X, Fan H . Interstitial pregnancy and transcervical curettage. Obstet Gynecol. 2004; 104(5 Pt 2):1193-5. DOI: 10.1097/01.AOG.0000132807.44055.f5. View

Nilsson S, Makela S, Treuter E, Tujague M, Thomsen J, Andersson G . Mechanisms of estrogen action. Physiol Rev. 2001; 81(4):1535-65. DOI: 10.1152/physrev.2001.81.4.1535. View

Bertrand G, LE Ray C, Simard-Emond L, Dubois J, Leduc L . Imaging in the management of abdominal pregnancy: a case report and review of the literature. J Obstet Gynaecol Can. 2009; 31(1):57-62. DOI: 10.1016/s1701-2163(16)34055-5. View

10.

Weigert M, Gruber D, Pernicka E, Bauer P, Feichtinger W . Previous tubal ectopic pregnancy raises the incidence of repeated ectopic pregnancies in in vitro fertilization-embryo transfer patients. J Assist Reprod Genet. 2008; 26(1):13-7. PMC: 2649331. DOI: 10.1007/s10815-008-9278-2. View

11.

Allibone G, FAGAN C, Porter S . The sonographic features of intra-abdominal pregnancy. J Clin Ultrasound. 1981; 9(7):383-7. DOI: 10.1002/jcu.1870090706. View

12.

Weibel H, AlSerri A, Reinhold C, Tulandi T . Multidose methotrexate treatment of cervical pregnancy. J Obstet Gynaecol Can. 2012; 34(4):359-362. DOI: 10.1016/S1701-2163(16)35217-3. View

13.

Bourdel N, Roman H, Gallot D, Lenglet Y, Dieu V, Juillard D . [Interstitial Pregnancy. Ultrasonographic diagnosis and contribution of MRI. A case report]. Gynecol Obstet Fertil. 2007; 35(2):121-4. DOI: 10.1016/j.gyobfe.2006.06.023. View

14.

Senapati S, Barnhart K . Biomarkers for ectopic pregnancy and pregnancy of unknown location. Fertil Steril. 2013; 99(4):1107-16. PMC: 3602335. DOI: 10.1016/j.fertnstert.2012.11.038. View

15.

Doubilet P, Benson C . Further evidence against the reliability of the human chorionic gonadotropin discriminatory level. J Ultrasound Med. 2011; 30(12):1637-42. DOI: 10.7863/jum.2011.30.12.1637. View

16.

Graczykowski J, Mishell Jr D . Methotrexate prophylaxis for persistent ectopic pregnancy after conservative treatment by salpingostomy. Obstet Gynecol. 1997; 89(1):118-22. DOI: 10.1016/s0029-7844(96)00370-5. View

17.

. Assisted reproductive technology in the United States: 2001 results generated from the American Society for Reproductive Medicine/Society for Assisted Reproductive Technology registry. Fertil Steril. 2007; 87(6):1253-66. DOI: 10.1016/j.fertnstert.2006.11.056. View

18.

Tulandi T, Al-Jaroudi D . Interstitial pregnancy: results generated from the Society of Reproductive Surgeons Registry. Obstet Gynecol. 2004; 103(1):47-50. DOI: 10.1097/01.AOG.0000109218.24211.79. View

19.

Elson J, Tailor A, Banerjee S, Salim R, Hillaby K, Jurkovic D . Expectant management of tubal ectopic pregnancy: prediction of successful outcome using decision tree analysis. Ultrasound Obstet Gynecol. 2004; 23(6):552-6. DOI: 10.1002/uog.1061. View

20.

Reyftmann L, Vernhet H, Boulot P . Management of massive uterine bleeding in a cesarean scar pregnancy. Int J Gynaecol Obstet. 2005; 89(2):154-5. DOI: 10.1016/j.ijgo.2004.11.030. View