Evidence-based management of non-tubal ectopic pregnancies

• Published in: Journal of obstetrics and gynaecology Vol. 37; no. 8; pp. 982 - 991
• Main Authors: Alalade, Aderemi Olaoluwa, Smith, Fredrick John Ennis, Kendall, Charlotte Emma, Odejinmi, Funlayo
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis 01-11-2017; Taylor & Francis Ltd
• Subjects: Abdomen; Abortifacient Agents - therapeutic use; Cervix Uteri; Cesarean Section; Cicatrix; ectopic pregnancy; Evidence-Based Medicine; extra-tubal; Female; Humans; Hysterectomy; Laparoscopy; Magnetic Resonance Imaging; management; Methotrexate - therapeutic use; non-tubal; Ovary; Pregnancy; Pregnancy, Ectopic - diagnosis; Pregnancy, Ectopic - surgery; Pregnancy, Ectopic - therapy; Risk Factors; Ultrasonography; extra-tubal; Laparoscopy; ectopic pregnancy; management; non-tubal
• ISSN: 0144-3615; 1364-6893
• DOI: 10.1080/01443615.2017.1323852

Recent advances in ultrasonography and the use of other modalities including magnetic resonance imaging scans have led to the early and more accurate diagnosis of non-tubal ectopic pregnancies (NTE). As a result, the management of these pregnancies has evolved. This article addresses the management options currently available for NTE. While surgical management remains the mainstay of treatment for ovarian, abdominal and cornual ectopics, there is growing evidence that some of these can be managed medically. Many authors have utilised a combination of medical and surgical approaches in the management of cervical and caesarean section (CS) scar ectopic pregnancies with good outcome. The availability of dedicated early pregnancy units has further improved diagnosis and more importantly the follow-up care for these patients. The rarity of cases and the difficulty of ethically organising randomised trials for NTE remain a problem in formulating consistent pathways for optimum management of women with NTE.