Unruptured ectopic pregnancy

Ectopic pregnancy

Ectopic pregnancy (EP) is defined as a pregnancy in which implantation of the embryo occurs outside the uterine cavity, most frequently in one of the two fallopian tubes or, rarely, in the abdominal cavity.

Unruptured ectopic pregnancy

Clinical presentation

• History of amenorrhoea

• Per vaginal spotting in early pregnancy

• Unilateral abdominopelvic pain

• Unilateral (localized) abdominal tenderness

Management of unruptured ectopic pregnancy

Referral

• Refer the patient to a higher-level facility with appropriate equipment and expertise

• At higher-level facilities, unruptured ectopic pregnancy may be managed surgically or pharmacologically depending on gestational age and available expertise

Pharmacological treatment

• Methotrexate (IV) 50 mg/m² as a single dose

OR

• Methotrexate (PO) 2.5 mg every 24 hours for 5 days if IV methotrexate is not available

Follow-up

• Perform weekly pelvic ultrasound to ensure regression of the gestational sac

Note

Contraindications to methotrexate include:

• Ruptured ectopic pregnancy

• Ectopic mass greater than 3.5 cm

• Presence of fetal cardiac activity

• High hCG level (>10,000 IU)

• Breastfeeding

• Immunodeficiency.