Ectopic pregnancy occurs when a fertilized egg implants somewhere other than the main cavity of the uterus. Pregnancy begins with a fertilized egg. Normally, the fertilized egg attaches itself to the lining of the uterus. An ectopic pregnancy most often occurs in one of the tubes that carry eggs from the ovaries to the uterus (fallopian tubes). This type of ectopic pregnancy is known as a tubal pregnancy.
The incidence of ectopic pregnancy is reported most commonly as the number of ectopic pregnancies per 1000 conceptions. Since 1970, when the reported rate in the United States was 4.5 cases per 1000 pregnancies, the frequency of ectopic pregnancy has increased 6-fold, with ectopic pregnancies now accounting for approximately 1-2% of all pregnancies. Consequently, the prevalence is estimated at 1 in 40 pregnancies, or approximately 25 cases per 1000 pregnancies. These statistics are based on data from the US Centers for Disease Control and Prevention (CDC), which used hospitalizations for ectopic pregnancy to determine the total number of ectopic pregnancies.
Methotrexate can be used to end a tubal pregnancy. Surgery can remove the pregnancy. Sometimes it is necessary to remove the tube with the pregnancy. This is called a salpingectomy. The tube may be removed through an opening in the abdomen. This is called an open procedure. It can also be removed through a small incision near the navel, using a laparoscope.
Recent reports affirm that ectopic pregnancy has become a medical rather than a surgical disease. Early diagnosis is the key to effective nonsurgical treatment. Diagnostic algorithms using serum progesterone, serial beta-human chorionic gonadotropin measurements, ultrasound, and office curettage now make definitive diagnosis possible without laparoscopy. Laparoscopic salpingostomy, the surgical gold standard, is an effective therapy but carries surgical complications and is expensive. Systemic variable dose methotrexate produces outcomes close to laparoscopic salpingostomy in similar patients. Single dose systemic methotrexate and intratubal methotrexate appear to be less effective. In many cases, ectopic pregnancies do not meet suitable medical criteria and still require surgery. The challenge today is identifying patients at risk and bringing them into the system during the early first trimester when treatment is simple.