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Ectopic pregnancy

Nature Reviews Disease Primers volume 10, Article number: 94 (2024) Cite this article

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Abstract

Ectopic pregnancy, defined as the implantation of a developing pregnancy outside of the endometrial cavity of the uterus, is the leading cause of early-pregnancy maternal mortality. The majority of ectopic pregnancies implant in a fallopian tube. Acute complications may include rupture of the fallopian tube or rupture of ectopic pregnancy, haemorrhage and hypovolaemic shock, or occur secondary to treatments such as emergency surgery or blood transfusions, and ultimately increase the risk of maternal death. After ectopic pregnancy, patients may experience ongoing morbidity, including chronic pain, infertility and psychological distress. Assessment of ectopic pregnancy should focus on prompt diagnosis based on clinical and investigative findings but should also reflect a patient-centred approach with acknowledgement of potential psychological distress associated with pregnancy loss and reduced future fertility. Over the last four decades, the foundations of non-invasive diagnosis have been transvaginal sonography and serum β-human chorionic gonadotropin, with diagnostic laparoscopy as a confirmatory test if surgical treatment is planned. Once diagnosed, ectopic pregnancy can be managed expectantly, treated medically with methotrexate or managed surgically. Future fertility is an important but often overlooked aspect in the management of ectopic pregnancy.

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Fig. 1: Anatomic locations of EP.
Fig. 2: Ultrasonography features of tubal EP.
Fig. 3: Grading of haemoperitoneum.
Fig. 4: Algorithm for initial management of early-pregnancy bleeding.
Fig. 5: Considerations for the management of ectopic pregnancy.

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Authors and Affiliations

  1. Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia

    Krystle Y. Chong & Ben W. Mol

  2. Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa

    Liesl de Waard

  3. The Ectopic Pregnancy Trust, London, UK

    Munira Oza

  4. Centre for Reproductive Medicine, Amsterdam Reproduction & Development Research Institute, Amsterdam UMC, Amsterdam, The Netherlands

    Madelon van Wely & Ben W. Mol

  5. Elizabeth Garrett Anderson Institute for Women’s Health, University College London, London, UK

    Davor Jurkovic & Maria Memtsa

  6. Aberdeen Centre for Women’s Health Research, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK

    Andrea Woolner & Ben W. Mol

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  1. Krystle Y. Chong
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  2. Liesl de Waard
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Contributions

Introduction (K.Y.C.); Epidemiology (B.W.M., M.v.W. and L.d.W.); Mechanisms/pathophysiology (D.J.); Diagnosis, screening and prevention (K.Y.C.); Management (K.Y.C. and A.W.); Quality of life (B.W.M. and M.O.); Outlook (M.M.). B.W.M. supervised the project. All authors provided critical feedback and contributed to the final version of the manuscript.

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Correspondence to Ben W. Mol.

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Competing interests

M.v.W. reports leading the Netherlands Satellite of the Cochrane Gynaecology and Fertility Group. B.W.M. reports grants from the National Health and Medical Research Council, Guerbet and Merck, outside of the submitted work. The other authors declare no competing interests.

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Chong, K.Y., de Waard, L., Oza, M. et al. Ectopic pregnancy. Nat Rev Dis Primers 10, 94 (2024). https://doi.org/10.1038/s41572-024-00579-x

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