Ectopic pregnancy

Implantation and development of an embryo outside the uterine cavity. The embryo draws a blood supply from the site of implantation. Very rarely viable. More commonly results in miscarriage and can cause rupture of the ectopic implantation site (commonly the Fallopian tubes) with potentially life-threatening haemorrhage.

All women are pregnant until proven otherwise. All pregnancies are ectopic until proven otherwise. All women are liars until proven otherwise.  – Adage. Sounds objectionable, but bearing it in mind may prevent avoidable deaths

If suspected, send immediately to hospital.

Diagnosis is easy if it presents with abdominal pain, vaginal bleeding and amenorrhoea (or a positive pregnancy test). However, atypical presentations may not have these features. Very rarely, the presence of a viable uterine and an ectopic pregnancy is known as a heterotopic pregnancy.


  • Ultrasound
  • Serum β-HCG – often serial levels (which should double every 48 hours in normal viable uterine pregnancy).


Usually surgical, but sometimes treated medically with methotrexate.(1)(2)

1.Combined chemotherapy in the medical management of tubal pregnancy:

The medical management of early unruptured tubal ectopic pregnancies is gaining acceptance internationally as an alternative to surgical procedures. This method has been shown to be effective and safe in properly selected cases and with adequate supervision. Most of the work however has been done using either methotrexate or prostaglandins. The present study aimed to evaluate the efficacy of a combined therapeutic regimen. The efficacy was noted to be at least as good but with fewer side-effects. The treatment was effective in 18 out of 19 cases of tubal pregnancies (94.7%). One patient complained of a gastritis which resolved with antacids. One patient experienced abdominal cramps and transient hypotension probably as a profound vagal response during tubal abortion. The median time to resolution varied directly with the initial serum beta HCG level at diagnosis. All patients who responded to the therapy described the experience as painless and viewed the treatment positively as it spared them the need for surgery and its attendant anaesthetic risks. However, we strongly recommend caution and close supervision and to keep the patient in the hospital at least for the first week of therapy.

2.Use of “2-dose” regimen of methotrexate to treat ectopic pregnancy:

This “2-dose” protocol minimizes the number of injections and surveillance visits, compared with the “multiple dose” regimen, and methotrexate is administered more frequently than with the “single dose” regimen. The protocol may optimize the balance between convenience and efficacy. In a limited number of women, no safety concerns were noted with up to 4 doses of methotrexate in a 2-week period without leucovorin rescue.

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See also Abortion

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