Tubal pregnancy: a review of current diagnosis and treatment

Ectopic pregnancy accounts for 2 percent of all pregnancies in the United States, and contributes substantially to maternal morbidity and mortality. Risk factors for the development of ectopic pregnancy are described, but less than 50 percent of women with ectopic pregnancy actually give a history of such risk factors. The initial history and physical examination of patients who eventually are found to have ectopic pregnancy can be misleading, resulting in early misdiagnosis. Failure to diagnose ectopic pregnancy before tubal rupture limits treatment options. However, with a high index of suspicion, and a combination of biochemical and ultrasound parameters, early diagnosis of ectopic pregnancy can be achieved, permitting medical or conservative surgical treatment options. Future reproductive potential after treatment of ectopic pregnancy is limited, with only approximately one third of affected women ever subsequently delivering a live-born infant. Future fertility is more dependent on the condition of the contralateral fallopian tube than on the specific type of therapy used to treat the affected tube. There is no consensus on which treatment is most effective, minimizing the risk of persistent ectopic pregnancy, while providing the optimum future fertility potential.