Clinical Review Regular Review

Ectopic pregnancy

BMJ 2000; 320 doi: https://doi.org/10.1136/bmj.320.7239.916 (Published 01 April 2000) Cite this as: BMJ 2000;320:916
  1. J I Tay, lecturer,
  2. J Moore, research fellow,
  3. J J Walker, professor (j.j.walker@leeds.ac.uk)
  1. Division of Obstetrics and Gynaecology, St James's University Hospital, Leeds LS9 7TF
  1. Correspondence to: J J Walker

    Ectopic pregnancy (fig 1) causes major maternal morbidity and mortality, with pregnancy loss, and its incidence is increasing worldwide.13 In northern Europe between 1976 and 1993 the incidence increased from 11.2 to 18.8 per 1000 pregnancies,2 and in 1989 in the United States admissions to hospital for ectopic pregnancy increased from 17 800 in 1970 to 88 400.4 These changes were greatest in women over 35 years of age.2 4 In the United Kingdom there are around 11 000 cases of ectopic pregnancy per year (incidence 11.5 per 1000 pregnancies), with four deaths (a rate of 0.4 per 1000 ectopic pregnancies).1

    Summary points

    The incidence of ectopic pregnancy is increasing, mainly due to the increased incidence of pelvic inflammatory disease caused by Chlamydia trachomatis

    Ectopic pregnancy must be excluded in a sexually active woman with a positive pregnancy test, abdominal pain, and vaginal bleeding

    Early ultrasonography should be available in subsequent pregnancies for women who have had an ectopic pregnancy

    Diagnosis cannot be made clinically or in the community

    Treatment should be tailored to individual needs; in selected cases medical management can be as effective as laparoscopic salpingostomy

    Conservative surgery results in slightly higher rates of intrauterine pregnancy and higher recurrent ectopic pregnancies

    Fig 1.

    Sites of ectopic pregnancies

    Methods

    We review the incidence, causes, diagnosis, and management of ectopic pregnancy. The evidence presented is from a combination of selected published papers identified from Medline and a reflection of clinical practice in our unit. Medline was searched with the term “ectopic pregnancy” and combined with terms such as incidence, risk factors, methotrexate, salpingectomy, salpingostomy, etc.

    Risk factors

    Although a proportion of women with ectopic pregnancy have no identifiable causal factors, the risk is increased by several factors: previous ectopic pregnancy,5 tubal damage from infection or surgery,6 a history …

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