New Evidence to Guide Ectopic Pregnancy Diagnosis and Management

Importance Ectopic pregnancy is a leading source of morbidity and mortality in pregnancy, accounting for 1% to 2% of all pregnancies. Timely diagnosis and management of these abnormal gestations are vital to patient safety. Objective The objective of this study was to describe recent evidence in the risk factors, diagnosis, and management of ectopic pregnancy. Evidence Acquisition Comprehensive review of the published literature. Results Recent literature describes newly identified risk factors for ectopic pregnancy, particularly those specific to assisted reproduction. Furthermore, evidence mounts for the utility of endometrial sampling for the diagnosis of pregnancy location, allowing a significant proportion of women to avoid methotrexate by diagnosing failing intrauterine pregnancies instead. Finally, recent, high-level evidence supports (in women with normal contralateral fallopian tubes) the equivalence of salpingectomy and salpingostomy regarding rates of subsequent intrauterine pregnancy and recurrent ectopic pregnancy. Conclusions and Relevance While serial serum human chorionic gonadotropin levels and transvaginal ultrasound are the mainstays of ectopic pregnancy diagnosis, recent publications revisit the utility of endometrial sampling in diagnosing pregnancy location, using manual vacuum aspiration instead of the criterion-standard dilation and curettage. Expectant management of ectopic pregnancies is the subject of ongoing research, and in the meantime, treatment remains medical or surgical (dependent on clinical parameters and patient preference); salpingostomy and salpingectomy provide equivalent subsequent pregnancy outcomes in women with contralateral fallopian tubes in place. Target Audience Obstetricians and gynecologists, family physicians. Learning Objectives After completing this activity, the learner should be better able to describe risk factors for ectopic pregnancies, including specifics of assisted reproduction; discuss updated diagnosis algorithms for pregnancies of unknown location, including recent data regarding endometrial sampling; and discuss top-level evidence regarding management of ectopic pregnancy, including expectant management, medical treatment with various methotrexate regimens, and surgical management with salpingectomy versus salpingostomy.