Table 5.
Summary of treatment recommendations for various types of ectopic pregnancies (EP).
| Type | Medical management | Surgical management | Expectant management |
|---|---|---|---|
| Tubal | Intramuscular (IM) methotrexate (MTX) may be considered
for: • Clinically stable patients with unruptured EP |
Recommended for: • Hemodynamically unstable patients May be considered for: • Clinically stable patients with unruptured EP Options include minimally invasive laparoscopy |
— |
| Interstitial | IM MTX may be considered for: • Hemodynamically stable patients |
Hysterectomy recommended for: • Patients who experience life-threatening hemorrhage • Patients who do not wish to maintain fertility Laparoscopic guided cornual resection recommended for: • Patients who wish to maintain fertility |
— |
| Cesarean Scar (CSP)a | • Intra-gestational MTX is the treatment of choice for medical
management • Systemic IM MTX on its own is not recommended |
Common approach: • Surgical resection with transvaginal or laparoscopic approach Alternative approaches: • Ultrasound (US)-guided vacuum aspiration • Hysterectomy (if future fertility is not desired) Sharp curettage alone should be avoided, due to risk of uterine rupture |
• Recommended against by Society for Maternal Fetal Medicine |
| Heterotopica | • IM MTX is contraindicated given simultaneous presence of an intrauterine pregnancy (IUP) | Approaches: • Salpingectomy/Salpingostomy • US-guided ablation • Laparoscopic removal of the EP Note: Surgical management has the worst outcomes for IUP |
• Greatest maternal mortality |
| Cervical | MTX can be administered in one of the following
ways: • Systemically via IM injection • Directly into the amniotic cavity Optional: • Supplementation with intraamniotic potassium chloride injection to increase efficacy |
Fertility preserving techniques that allow for bleeding
control: • Uterine artery embolization • Balloon tamponade • Endocervical curettage Cerclage can augment balloon tamponade in patients with severe hemorrhage |
– |
| Ovarian | • Not a common approach | • Gold standard for treatment • All attempts are made to preserve as much ovarian reserve as possible |
|
| Abdominal | – | • Standard treatment | • Recommended against due to risk of catastrophic intra-abdominal hemorrhage |
Source: Table modified and summarized from Houser et al.1
EP: ectopic pregnancy; IM: intramuscular; MTX: methotrexate; CSP: Cesarean scar pregnancy; US: ultrasound; IUP: intrauterine pregnancy.
a
There is no standardized treatment or algorithm for management, but common approaches are described.