Diagnosis and treatment of ectopic pregnancy

Ectopic pregnancy refers to implantation of an embryo outside the endometrium. It is a medical emergency, but associated maternal mortality has significantly declined over the decades due to earlier diagnosis and treatment. Timely detection of ectopic pregnancy is contingent on having a high index of suspicion in all women of reproductive age, identifying patient risk factors, and then performing appropriate laboratory testing and imaging. Expectant management is less commonly used than medical management, which is preferred for asymptomatic, vitally stable women who wish to avoid surgery. Minimally invasive surgery is the gold standard for management of unstable or ruptured ectopic pregnancy. Recent data favor salpingectomy for women with a healthy contralateral tube because it has higher treatment success and does not appear to reduce future fertility compared to salpingotomy. However, salpingotomy is suggested for women with a dysfunctional or absent contralateral tube, or those who elect to preserve both tubes and accept the increased risk of treatment failure. Knowledge of the risks and benefits of each treatment option is critical for delivering patient-centred care.