Extrauterine pregnancy

Abstract

Extrauterine pregnancies contribute substantially to maternal mortality in all parts of the world. The most common cause of
these deaths is massive bleeding after rupture of the ectopic pregnancy. The advent of transvaginal ultrasonography in early
pregnancy and the use of quantitative measurement of the β-unit of human chorionic gonadotropin have revolutionized the
management of this condition. These diagnostic modalities allow its early detection and, in many cases, treatment before rupture
occurs. There is an ever increasing body of evidence supporting expectant, medical, and surgical management of ectopic
pregnancy according to certain criteria. The indications and criteria for the different management options are described in the
literature and in clear guidelines from institutions such as the Royal College of Obstetricians and Gynaecologists. Methotrexate,
in a single dose protocol, is widely used in the medical management of ectopic pregnancy. Surgical therapy can be either
laparoscopic or via laparotomy. Be that as it may, ruptured ectopic pregnancy will continue to present as a gynecologic emergency
requiring prompt and appropriate care. Resuscitation of these patients should be an organized, systematic, and rapid process
with the ultimate goal of getting them to the operating theatre in the best possible hemodynamic status. The aim of surgery
should be to stop active bleeding by the most expedient method. The use of autotransfusion is well established in cardiac
surgery, vascular surgery, orthopedic surgery, and trauma. Using autologous blood should be considered also in the treatment
of ruptured extrauterine pregnancy when faced with massive bleeding and a need for transfusion. Despite a reduction in maternal
mortality due to ectopic pregnancy in the developed world during the preceding period, it would appear that no further inroads
have been made in the last two decades. In developing countries, the problem is far greater, and problems with resources and
infrastructure persist. It remains a challenge to all practitioners caring for women to apply available resources and use the
published evidence-based guidelines to manage these women effectively and safely.

O & G Forum Vol. 17 (1) 2007: pp. 6-11