Ectopic pregnancy

Ectopic pregnancy, defined as the implantation of a developing pregnancy outside of the endometrial cavity of the uterus, is the leading cause of early-pregnancy maternal mortality. The majority of ectopic pregnancies implant in a fallopian tube. Acute complications may include rupture of the fallopian tube or rupture of ectopic pregnancy, haemorrhage and hypovolaemic shock, or occur secondary to treatments such as emergency surgery or blood transfusions, and ultimately increase the risk of maternal death. After ectopic pregnancy, patients may experience ongoing morbidity, including chronic pain, infertility and psychological distress. Assessment of ectopic pregnancy should focus on prompt diagnosis based on clinical and investigative findings but should also reflect a patient-centred approach with acknowledgement of potential psychological distress associated with pregnancy loss and reduced future fertility. Over the last four decades, the foundations of non-invasive diagnosis have been transvaginal sonography and serum β-human chorionic gonadotropin, with diagnostic laparoscopy as a confirmatory test if surgical treatment is planned. Once diagnosed, ectopic pregnancy can be managed expectantly, treated medically with methotrexate or managed surgically. Future fertility is an important but often overlooked aspect in the management of ectopic pregnancy.