Editorials

The changing face of ectopic pregnancy

BMJ 1997; 315 doi: https://doi.org/10.1136/bmj.315.7101.141 (Published 19 July 1997) Cite this as: BMJ 1997;315:141

Laparoscopic or medical treatment should now replace laparotomy

  1. Lawrence Mascarenhas, Subspecialty senior registrara,
  2. John Williamson, Consultanta,
  3. Steve Smith, Professora
  1. a University Department of Obstetrics and Gynaecology, Rosie Maternity, Addenbrooke's Hospital NHS Trust, Cambridge CB2 2SW

    Technological advances have revolutionised the diagnosis and management of ectopic pregnancy, a century after Lawson Tait successfully performed a laparotomy to ligate the broad ligament and remove a ruptured tube in 1883.1 However, just as women are undergoing unnecessary surgery for menorrhagia,2 most women in Britain who have an ectopic pregnancy undergo laparotomy3 despite the evidence in favour of laparoscopic or medical treatment.4

    Ectopic pregnancy is a great masquerader. The clinical presentation varies from vaginal spotting to vasomotor shock with haemoperitoneum, making the accuracy of clinical diagnosis about 50%.5 Risk factors are present in 25-50% of patients and include a history of pelvic inflammatory disease, tubal surgery, or ectopic pregnancy; non-puerperal sterilisation; assisted reproduction; and the use of a progesterone (but not levonorgestrel or copper) intrauterine device.5 Thus, any woman of childbearing age who has abdominal pain, vaginal bleeding, or amenorrhoea …

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