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ECTOPIC PREGNANCY
Ectopic pregnancy happens when the fertilized ovum implants outside the endometrial lining of the uterus.
Accurate early diagnosis is life-saving, reduces invasive diagnostic procedures & allows conservative treatment that can preserve fertility.
Ectopic pregnancy must be excluded in women of reproductive age w/ a positive pregnancy test, abdominal pain & vaginal bleeding.
Ruptured ectopic pregnancy remains to be the leading cause of maternal mortality in the first trimester.

Patient Education

  • Advise the patient on the advantages and disadvantages of each treatment option
  • Women may grieve at the loss of pregnancy and may need appropriate support
  • Explain that fertility rates after either medical or surgical management are similar in patients with no history of subfertility or tubal pathology  
    • In patients with a history of subfertility, improved reproductive outcomes are observed with medical or expectant management than with surgery 
  • Women undergoing medical management should avoid alcoholic beverages, NSAIDs, vitamins containing folic acid, sexual intercourse, sun exposure due to risk of Methotrexate dermatitis, and ultrasound and pelvic examinations during Methotrexate therapy surveillance
  • Patient with confirmed ectopic pregnancy should avoid using intrauterine device as contraception since this can increase the chance of ectopic pregnancy
  • Describe the side effects of medical therapy and symptoms to monitor (eg severe abdominal pain, lightheadedness)
  • Patients should be advised regarding their risk of future ectopic pregnancy
    • In patients with no history of subfertility or tubal pathology, no difference in the risk of future tubal ectopic pregnancy or tubal patency rates is seen between the different management approaches
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