Clinical Review

Diagnosis and management of ectopic pregnancy

BMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d3397 (Published 10 June 2011) Cite this as: BMJ 2011;342:d3397
  1. Davor Jurkovic, consultant gynaecologist1,
  2. Helen Wilkinson, director2
  1. 1Department of Obstetrics and Gynaecology, University College Hospital, London NW1 2BU, UK
  2. 2Ectopic Pregnancy Trust, King’s College Hospital, London, UK
  1. Correspondence to: D Jurkovic davor.jurkovic{at}uclh.nhs.uk

Summary points

  • The prevalence of ectopic pregnancy is 1-2% and it is an important cause of maternal morbidity and mortality

  • Consider ectopic pregnancy in all pregnant women presenting with abdominal pain or vaginal bleeding

  • Women with a history of ectopic pregnancy, tubal surgery, or tubal pathology are at increased risk, as are those who have had tubal ligation or who have an intrauterine contraceptive device in place

  • A transvaginal ultrasound scan is the best test to diagnose ectopic pregnancy

  • Laparoscopic surgery is the main treatment; medical and expectant management is used in a select group

  • Women who are treated for ectopic pregnancy have significantly lower subsequent spontaneous intrauterine pregnancy rates and higher ectopic pregnancy rates than the general population

The estimated prevalence of ectopic pregnancy is 1-2% worldwide. In the United Kingdom nearly 12 000 ectopic pregnancies are diagnosed each year, which gives a prevalence of 1.1%.1 Although death after ectopic pregnancy is rare, the burden of disease is high owing to the cost of diagnostic tests and expensive treatment.2 Serious adverse outcomes in ectopic pregnancies are typically caused by delayed diagnosis; this highlights the need for primary care and secondary care health professionals to be familiar with the risk factors for ectopic pregnancy, its clinical symptoms, and the local facilities that provide care for women with early pregnancy problems. In recent years it has become more common to treat women with ectopic pregnancy conservatively in the outpatient setting.3 General practitioners increasingly advise women on different management options and support them during follow-up.

Sources and selection criteria

We searched Embase and Medline for articles with titles that included the keywords “ectopic pregnancy” and “extrauterine pregnancy”. We limited the search to meta-analyses, reviews, and randomised controlled trials published in English in the past 10 years. We consulted a systematic review on ectopic pregnancy in the …

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