IMR Press / CEOG / Volume 49 / Issue 12 / DOI: 10.31083/j.ceog4912262
Open Access Review
Ectopic Pregnancy: An Overview
Show Less
1 Department of Biomedical Sciences and Human Oncology, Gynaecologic and Obstetrics Clinic, University of Bari ALDO MORO, 70121 Bari, Italy
2 Division of Gynaecologic and Obstetrics Clinic, Dario Camberlingo, 72021 Francavilla Fontana, Italy
3 Division of Gynaecologic and Obstetrics Clinic, Hospital of Matera, Madonna delle Grazie, 75100 Matera, Italy
*Correspondence: damiani14@alice.it (Gianluca Raffaello Damiani)
Academic Editor: Yoon Ha Kim
Clin. Exp. Obstet. Gynecol. 2022, 49(12), 262; https://doi.org/10.31083/j.ceog4912262
Submitted: 4 July 2022 | Revised: 20 August 2022 | Accepted: 1 September 2022 | Published: 22 November 2022
(This article belongs to the Special Issue Treatment and Management of Ectopic Pregnancy)
Copyright: © 2022 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.
Abstract

Objectives: Purpose of this narrative review is to compare, the latest findings about ectopic pregnancy (EP) reporting pathogenetic hypothesis, common and uncommon symptoms, diagnostic work-up, treatment alternatives. EP is a pathological condition characterized by an abnormal blastocyst implant at any site apart from uterine cavity. Dealing with pathogenesis we can recognize many factors: hormonal imbalance, post infective or mechanical induced defects of the tube, assisted reproduction techniques. This condition has aroused interest for its capacity to evolve instantly in a life-threatening condition, needing an early diagnosis and an urgent surgical solution. Mechanism: A comprehensive literature research of recent articles has been performed. Researches for relevant data were conducted utilizing multiple databases, including PubMed, SCOPUS and Ovid. Searches included combinations of the key terms: tubal pregnancy, cervical pregnancy, cesarean scar pregnancy, ‘twin and ectopic pregnancy’, ‘twin and tubal pregnancy’, ‘twin heterotopic pregnancy’, ‘laparoscopy and twin pregnancy’, ‘laparoscopy and tubal pregnancy’, ‘surgery and pregnancy’, ‘surgery and ectopic’, ‘surgery and twin tubal pregnancy’, “methotrexate and twin pregnancy ‘cornual pregnancy’ ”. Findings in brief: EP is frequently located in the salpinges but may also occur in many other sites like uterine horns, cervix, ovaries, cesarean scar or in splanchnic organs. Typical signs and symptoms of EP usually consist of pelvic pain, vaginal bleeding or sudden amenorrhea. Beta-human chorionic gonadotropin (b-hCG) dosages are fundamental tools for diagnosis of the early pregnancy whether is normal or not, always considering tubal pregnancy a possible event. Imaging diagnostic tools are described in our review, Ultrasound, Magnetic resonance imaging (MRI), Computed Tomography (CT) are the main options. When the serum b-hCG is positive but at ultrasound examination of pregnancy cannot be found, physician must define this condition as a pregnancy of unknown location (PUL). In this literature-based review we found three therapeutic solutions: expectant, medical or surgical management. Expectant strategy consists of strictly monitoring b-hCG values with no pharmacological or surgical intervention. Methotrexate administration following therapeutic schemes is a cost-effective solution and keeps patient away from surgical risks. Surgery maintains a key role in treatment choice considering that is the only one available in emergency scenario. Conclusions: EP is a diagnostic challenge for the physician, therapy choice is a careful and difficult decision that must be always individualized to ensure patient life uppermost and also future fertility desire.

Keywords
ectopic pregnancy
tubal pregnancy
abdominal pregnancy
ultrasound
methotrexate
laparoscopy
Share
Back to top