15 - Tubal ectopic pregnancy

Summary

Tubal ectopic pregnancy is an important cause of maternal morbidity and mortality worldwide. Clinical presentation of ectopic pregnancy varies from mild vaginal bleeding to sudden rupture and massive intra-abdominal haemorrhage. The diagnosis of the ectopic pregnancy was made at surgery and then confirmed on histological examination following salpingectomy. At laparoscopy, an unruptured ectopic pregnancy typically presents as a well-defined swelling in the fallopian tube. The diagnosis of intrauterine pregnancy becomes more difficult if the uterus is enlarged by fibroids. Fibroids often distort the shape of the endometrial cavity and prevent the operator from visualising in a single plane the continuity between the gestation sac and the cervical canal. Surgery remains the main therapeutic option for the treatment of tubal ectopic pregnancy. Medical management of ectopic pregnancy has grown in popularity following observational studies which reported success rates greater than 90% with single-dose systemic methotrexate.