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Ectopic pregnancy causes 15% of all maternal deaths. Teenagers have the highest mortality rates. Once a patient has had an ectopic, there is a 7-to 13-fold increase in the risk of recurrence. Factors that have been shown to increase the risk of tubal pregnancy include 1) previous pelvic inflammatory disease, 2) previous tubal surgery, 3) current use of
Other factors proposed to increase the risk of ectopic gestation increase the risk of ectopic.
I. Evaluation
A. The classic symptom triad of pain, amenorrhea, and vaginal bleeding is most commonly found only in patients in whom an ectopic has ruptured. The history and physical examination alone are inadequate for the diagnosis of an unruptured ectopic.
B. beta-hCG level greater than the ultrasound discriminatory zone indicates a possible extrauterine. Serial testing is usually needed 1) to differentiate from a completed abortion, 2) for patients in whom ultrasonography examinations are inconclusive, or 3) is one that has reached a plateau. or intrauterine.
C. Serum progesterone level in patients with is lower than with a normal intrauterine. About 70% of patients with a viable, tubal intrauterine have serum progesterone levels greater than 25 ng/mL, whereas only 1.5% of patients with an serum progesterone levels greater than 25 ng/mL. A serum progesterone level less than 5 ng/mL is highly suggestive of an abnormal.
D. Transvaginal ultrasonography. Unless an adnexal gestational sac with a fetal pole and cardiac activity is visualized, accurate interpretation of ultrasonography findings requires correlation with the b-hCG level.
E. Uterine curettage can be used to differentiate an early nonviable intrauterine from an extrauterine. In 95% of cases, uterine contents will float in a saline solution. Because the test is not 100% accurate, histologic confirmation or follow-up b-hCG levels are required. If the uterus is evacuated and the is extrauterine, the hCG level will plateau or continue to rise, indicating the presence of extrauterine trophoblastic tissue. A spontaneously resolving may be found.
F. Laparoscopy can be used for both the diagnosis and treatment of the ectopic gestation, although the diagnosis is missed in 2-4% of patients who have very small ectopic gestations.
II. Treatment
A. Ectopic can be treated medically or surgically. Both methods are