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Ectopic Pregnancy

  1. Ioannis E. Messinis, Expert8
  1. 1 Department of Laboratory Medicine and Pathobiology, University of Toronto,
  2. 2 Department of Pathology and Laboratory Medicine, Mount Sinai Hospital,
  3. 3 Department of Clinical Biochemistry, University Health Network, Toronto, Ontario, Canada;
  4. 4 MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK;
  5. 5 Division of Reproductive Endocrinology and Infertility, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA;
  6. 6 Institute of Reproductive and Developmental Biology, Queen Charlotte's and Chelsea Hospital, Imperial College NHS Trust, London, UK;
  7. 7 Department of Woman and Child, University Hospitals Leuven, Campus Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium;
  8. 8 Department of Obstetrics and Gynaecology, Medical School, University of Thessaly, University Hospital, Larissa, Greece.
  1. * Address correspondence to this author at: Department of Clinical Biochemistry, University Health Network, University of Toronto, 60 Murray St., 6th Floor, Toronto, Ontario, Canada. Fax 416-586-8628; e-mail ediamandis{at}mtsinai.on.ca.

The first 20% of the full text of this article appears below.

An ectopic pregnancy occurs when an embryo implants outside of the uterus. In 98% of cases, the ectopic implantation takes place in the fallopian tube. Ectopic pregnancies occur in 1% to 2% of all pregnancies and remain an important cause of maternal morbidity and mortality in the first trimester. Although the etiology of ectopic pregnancy is poorly understood, epidemiologic studies have identified several risk factors for ectopic pregnancy: cigarette smoking, tubal damage from previous surgery, and Chlamydia trachomatis infection. These risk factors have been hypothesized to lead to embryo implantation within the fallopian tube by altering tubal smooth muscle contractility and the tubal microenvironment, leading to arrest of the embryo within the fallopian tube and an environment more apt to facilitate implantation.

Ectopic pregnancy can be difficult to diagnose, and most women present with pain and bleeding in the first trimester. These symptoms, however, are relatively common in early pregnancy, are not specific to ectopic pregnancy, and may be associated with other conditions, such as miscarriage. There are currently no specific biomarkers for ectopic pregnancy, and diagnosis relies on serial measurements of serum β-human chorionic gonadotropin (β-hCG)9 to monitor the β-hCG doubling time, as well as transvaginal ultrasound (TVS), to rule out the presence of an intrauterine pregnancy. In some cases, serum β-hCG concentration and ultrasound results may be inconclusive, and laparoscopy is required to make a diagnosis. In this Q&A, 4 experts discuss recent advances that help us understand the etiology of ecto- pic pregnancy and the available methods for diagnosing and treating ectopic pregnancy.

How is ectopic pregnancy currently being diagnosed in your institution?

Andrew W. Horne: In our institution, ectopic pregnancy is diagnosed with a combination of TVS and serial serum β-hCG monitoring.

Kurt Barnhart: The majority of women with ectopic pregnancy are identified with ultrasound. …

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