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Ectopic and Heterotopic Pregnancies

  • Mehmet Cihat Unlu
  • Gazi Yildirim
Chapter

Abstract

Ectopic pregnancy is a common and serious problem, with a significant morbidity rate and the potential for maternal death. The incidence of extrauterine pregnancy (EUP) is listed at 10–20 per 1000 pregnancies. In 95–97% of cases, this will be a tubal pregnancy. Ectopic pregnancy is the leading cause of pregnancy-related death in the first trimester. If a woman of reproductive age presents with abdominal pain, vaginal bleeding, syncope, or hypotension, the physician should have ectopic pregnancy in mind. Many patients have no documented risk factors and no physical indications of ectopic pregnancy. A combination of β-hCG titers with transvaginal ultrasonography (USG) is recommended whenever ectopic pregnancy is suspected. Earlier diagnosis, together with laparoscopy, led to the current standard of minimally invasive and tube-sparing diagnosis and treatment. In a symptomatic patient, the following applies: there is a suspicion of an EUP if the serum β-hCG value is above 1500 IU/L and the uterine cavity is seen as empty in vaginal sonography, without previous severe bleeding. Management is dictated by the clinical presentation, serum β-hCG levels, and transvaginal USG findings. MTX, as a single intramuscular injection, can be given to women who are hemodynamically stable and treatment adherent and have an initial serum β-hCG concentration of less than 5000 IU/L and no USG evidence of fetal cardiac activity. Patients who do not meet these criteria should be treated surgically, in most cases, by laparoscopy. Laparoscopic surgery is the cornerstone of treatment in the majority of women with tubal pregnancy. Surgical treatment is particularly appropriate for women who are hemodynamically unstable or unlikely to be adherent to posttreatment monitoring and those who do not have immediate access to medical care. The choice of treatment should be guided by the patient’s preference after a detailed discussion about monitoring, outcomes, and the risks and benefits of both approaches.

Keywords

Ectopic pregnancy Tubal ectopic Nontubal ectopic Heterotopic pregnancy 

Supplementary material

Video 26.1

Linear salpingotomy for tubal ampullary ectopic pregnancy (MPG 106880 kb)

Video 26.2

Partial salpingectomy for tubal interstitial ectopic pregnancy (MPG 63596 kb)

Video 26.3

Partial salpingectomy for tubal ampullary ectopic pregnancy. Patient had an ectopic pregnancy in the same tuba, and 1 year ago partial salpingectomy was performed. Ectopic mass can be seen at the distal blind end of the same tuba uterina (MPG 39392 kb)

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Mehmet Cihat Unlu
    • 1
  • Gazi Yildirim
    • 2
  1. 1.Department of Obstetrics and Gynecology, Bakirkoy HospitalAcibadem UniversityIstanbulTurkey
  2. 2.Department of Obstetrics and GynecologyYeditepe University HospitalIstanbulTurkey

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