Chapters authored
Non-tubal Ectopic Pregnancy: Diagnosis and Management
Ectopic pregnancy is the leading cause of maternal mortality in the first trimester, and prompt diagnosis and intervention are essential to ameliorate its associated complications. A majority of ectopic pregnancies are tubal, but extra-tubal pregnancy may pose more challenges in diagnosis and treatment. Early diagnosis of extra-tubal pregnancies requires high index of suspicion using transvaginal ultrasound and at times complemented with the help of magnetic resonance imaging. Similar to tubal pregnancy, extra-tubal ectopic pregnancies can be treated using surgical approach via laparotomy versus laparoscopy, or medical intervention with methotrexate, potassium chloride and most recently, mifepristone and epidermal growth factor inhibitor (gefitinib). For abdominal and ovarian ectopic pregnancies, the best surgical approach is via laparotomy or laparoscopy, while for cervical ectopic pregnancy and cesarean scar pregnancy (CSP), initial medical treatment with methotrexate, then suction curettage under ultrasound guidance, or hysteroscopic resection can suffice. All patients with extra-tubal pregnancy should be well counseled about the associated complications, fertility preserving intervention, and need for prolong monitoring especially those that choose medical therapy.
Part of the book: Non-tubal Ectopic Pregnancy