Early abdominal ectopic pregnancy: challenges, update and review of current management

Key content Early abdominal ectopic pregnancy ( EAP ), though rare, has a high mortality rate. There are no pathognomic symptoms of abdominal pregnancy. Symptoms are akin as for other types of ectopic pregnancy, thus a high index of suspicion is necessary for diagnosis. The tool of choice for diagnosis is ultrasound but it only gives 50% accuracy when used along with clinical evaluation. On occasion, magnetic resonance imaging may help to diagnose EAP . Medical management is commonly used where potential life‐threatening bleeding is anticipated. A number of women who are treated medically may need subsequent treatment with multiple therapies. Surgical management requires a great deal of surgical expertise and in most cases a multidisciplinary approach in anticipation of possible life‐threatening bleeding during the operation. Learning objectives To outline the classification of EAP . To understand the common risk factors associated with EAP . To understand how to diagnose EAP . To be aware of the different medical and surgical management of EAP and the ethical issues associated with diagnosis and treatment. Ethical issues Distinguishing an abdominal pregnancy from the more common variants of ectopic pregnancy remains difficult and a definitive diagnosis is usually made at surgery. There is no established guidance available for the diagnosis and management of EAP . Many EAP are never diagnosed because of a successful response to medical management for a pregnancy of unknown location. As it is not uncommon to diagnose EAP for the first time during surgery, the difficulties in diagnosis prior to surgery means that patients require life‐saving surgery beyond the scope of the preoperative signed consent form.