Hu LH, Sandoval VJ, Hernández SAG, Vargas MJ

Language: Spanish
References: 10
Page: 28-36
PDF size: 452.97 Kb.

ABSTRACT

Ectopic pregnancy (EP) or extra uterine pregnancy, accepted from the Greek word ‘‘ektopos’’ meaning out of place, refers to the blastocyst implantation outside the uterine cavity endometrium. The fallopian tube is the dominant site in the majority of cases of ectopic pregnancy. Approximately, 75% of deaths in the first trimester and 9% of all pregnancy-related deaths are due to EP. The etilogy of EP is multifactorial. The postulated mechanism includes anatomic obstruction, abnormalities in tubal motility or ciliary function, abnormal conceptus, and chemotactic factors stimulating tubal implantation. The triad of pain, vaginal bleeding and amenorrhea was historically used to suspect a diagnosis of EP. The symptoms of EP are often non-specific and difficult to differentiate from those of other gynecological, gastrointestinal and urological disorders. The uso of transvaginal scan (TVS) has changed the diagnostic approach to one based on visualizing the ectopic mass. TVS has been demonstrated to be superior to transabdominal ultrasound (TAS). Management options include expectant management, medical treatment, conservative surgery and radical surgery. With early diagnosis, most women with ectopic pregnancy could be treated with methotrexate (MTX). Currently, there are three main treatment regimens for management of ectopic pregnancy with methotrexate: the multidose protocol, the singledose protocol, and the two-dose protocol.

REFERENCES

1. Rana P Kazmi I Singh R et al. Ectopic pregnancy: a review. Arch Gynecol Obstet. 2013; 288 (4): 747-757

2. Marion L Meeks G. Ectopic Pregnancy: History, Incidence, Epidemiology, and Risk Factors. Clinical Obstetrics and Gynecology. 2012; 55 (2): 376-386

3. Perkins K Boulet S Kissin D Jamieson D. Risk of Ectopic Pregnancy Associated With Assisted Reproductive Technology in the United States, 2001– 2011. Obstetrics & Gynecology. 2015; 125(1): 70-78.

4. Kirk E Bottomley C Bourne T. Diagnosing ectopic pregnancy and current concepts in the management of pregnancy of unknown location. Human Reproduction Update. 2013; 20(2): 250-261.

5. Mohan S Thomas M. Ectopic pregnancy: reappraisal of risk factors and management strategies. Int J Reprod Contracept Obstet Gynecol. 2015; 4(3): 709-715.

6. Capmas P Bouyer J Fernandez H. Treatment of ectopic pregnancies in 2014: new answers to some old questions. Fertility and Sterility. 2014; 101(3): 615-620.

7. Taheri M Bharathan R Subramaniam A Kelly T. A United Kingdom national survey of trends in ectopic pregnancy management. Journal of Obstetrics and Gynaecology. 2014; 34(6):508-511.

8. RCOG. Guideline number 21: The management of tubal pregnancy. Royal College of Obstetricians and Gynaecologists. 2004; RCOG Press.

9. Tulandi T. Ectopic pregnancy. Springer International Publishing. Switzerland. 2015

10. Mergenthal M Senapati S Zee J et al. Medical management of ectopic pregnancy with single-dose and 2-dose methotrexate protocols: human chorionic gonadotropin trends and patient outcomes. American Journal of Obstetrics and Gynecology. 2016; doi: 10.1016/j.ajog.2016.06.040