eMedicine Specialties > Radiology > Obstetrics/Gynecology

Ectopic Pregnancy: Follow-up

Author: Douglas Bourgon, MD, Diagnostic Radiologist, Image Guided Therapeutics
Coauthor(s): Eric Outwater, MD, Professor, Department of Radiology, University of Arizona; Gregory J Balmforth, MD, Staff Physician, Department of Diagnostic Radiology, University of Arizona Medical Center
Contributor Information and Disclosures

Updated: Jul 18, 2008

Intervention

No current routine radiologic interventions are used for ectopic pregnancy. Along with serial beta-HCG evaluations, follow-up imaging is often performed for conservative and medical management. Case reports of rare interstitial ectopic pregnancies treated with interventional radiology-guided uterine artery embolization have been documented.21

Expectant management

A subsegment of patients may be undergoing a spontaneous resolution of an ectopic pregnancy at the time of diagnosis. These patients tend to have small, unruptured gestational sacs, very low beta-HCG levels, and no symptoms. Expectant management with close observation can be undertaken in an attempt to increase possible future tubal patency. The risk of expectant management is significant, and sequelae include tubal rupture and hemorrhage. These patients need to be carefully selected and followed up.

Medical management

The treatment of ectopic pregnancy with the administration of cell-growth inhibitors (methotrexate) is becoming increasingly common.22 This is largely the result of improved methods of detection and the diagnosis of early, unruptured ectopic pregnancies. Medical management is desirable because tubal patency may be preserved, therefore lowering the risk of a future ectopic pregnancy. Injections are typically given systemically, although a direct injection into the gestational sac under ultrasonographic guidance may be performed. Single and multidose regimens are now used with individual advantages and disadvantages.22,23 With either regimen, though, patients must be closely followed up with serial beta-HCG determinations, and surgical intervention may still be necessary in some cases.

Surgical management

Surgical resection of the involved fallopian tube remains the definitive therapy. Laparoscopic salpingostomy is now being used as a more conservative surgical approach to potentially preserve the fallopian tube.

Related eMedicine topics:

 Bedside Ultrasonography, First-Trimester Pregnancy

Surgical Management of Ectopic Pregnancy

Medicolegal Pitfalls

  • Possible compromise of normal intrauterine pregnancy if treatment is instituted before ectopic pregnancy is definitively diagnosed
  • Significant morbidity and mortality associated with a delayed or late diagnosis
  • Future risks of ectopic pregnancy or infertility

Special Concerns

  • Approximately 5% of all patients with a proven ectopic pregnancy go straight to surgery without imaging of any type.2
  • Surgical evaluation should not be delayed for imaging evaluation in a patient who is in unstable condition and who has undergone a proper clinical assessment.
 


More on Ectopic Pregnancy

Overview: Ectopic Pregnancy
Imaging: Ectopic Pregnancy
Follow-up: Ectopic Pregnancy
Multimedia: Ectopic Pregnancy
References
Further Reading
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References

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  33. Nishino M, Hayakawa K, Kawamata K, Iwasaku K, Takasu K. MRI of early unruptured ectopic pregnancy: detection of gestational sac. J Comput Assist Tomogr. Jan-Feb 2002;26(1):134-7. [Medline].

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Further Reading

Clinical guidelines:

Undifferentiated vaginal bleeding/abdominal pain suggestive of ectopic pregnancy clinical pathway. Maine Medical Center, Department of Emergency Medicine - Hospital/Medical Center.  2006 Aug.  Various pagings.  NGC:005248

Medical management of ectopic pregnancy. American College of Obstetricians and Gynecologists - Medical Specialty Society.  1998 Dec (revised 2008 Jun).  7 pages.  NGC:006533

Clinical studies:
Two-Dose Methotrexate for Ectopic Pregnancy

Ectopic Pregnancy Biomarkers

Risk Factors of Ectopic Pregnancy

Evaluation of Therapeutic Strategies for Treatment of Ectopic Pregnancies (EP) and Evaluation of Subsequent Fertility

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Keywords

ectopic pregnancy, ectopic gestation, extrauterine gestation, heterotopic pregnancy, metacyesis, eccyesis, interstitial ectopic, cornual ectopic, cervical ectopic, fimbrial ectopic, ovarian ectopic, ovarian pregnancy, peritoneal ectopic, tubal pregnancy, abdominal pregnancy, pelvic inflammatory disease

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Contributor Information and Disclosures

Author

Douglas Bourgon, MD, Diagnostic Radiologist, Image Guided Therapeutics
Douglas Bourgon, MD is a member of the following medical societies: American College of Radiology, American Medical Association, American Roentgen Ray Society, and Radiological Society of North America
Disclosure: Nothing to disclose.

Coauthor(s)

Eric Outwater, MD, Professor, Department of Radiology, University of Arizona
Eric Outwater, MD is a member of the following medical societies: American College of Radiology, Phi Beta Kappa, and Radiological Society of North America
Disclosure: Nothing to disclose.

Gregory J Balmforth, MD, Staff Physician, Department of Diagnostic Radiology, University of Arizona Medical Center
Disclosure: Nothing to disclose.

Medical Editor

Harris L Cohen, MD, FACR, Vice Chairman/Associate Chairman (Research Activities), Director, Division of Body Imaging, Professor of Radiology, Stony Brook School of Medicine; Visiting Professor of Radiology, Johns Hopkins School of Medicine
Harris L Cohen, MD, FACR is a member of the following medical societies: American College of Radiology, American Institute of Ultrasound in Medicine, Association of Program Directors in Radiology, Radiological Society of North America, Society for Pediatric Radiology, and Society of Radiologists in Ultrasound
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

Karen L Reuter, MD, FACR, Professor, Department of Radiology, Lahey Clinic Medical Center
Karen L Reuter, MD, FACR is a member of the following medical societies: American Association for Women Radiologists, American College of Radiology, American Institute of Ultrasound in Medicine, American Roentgen Ray Society, and Radiological Society of North America
Disclosure: Nothing to disclose.

CME Editor

Robert M Krasny, MD, Consulting Staff, Department of Radiology, The Angeles Clinic and Research Institute
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

Eugene C Lin, MD, Consulting Radiologist, Virginia Mason Medical Center; Clinical Assistant Professor of Radiology, University of Washington School of Medicine
Eugene C Lin, MD is a member of the following medical societies: American College of Nuclear Medicine, American College of Radiology, Radiological Society of North America, and Society of Nuclear Medicine
Disclosure: Nothing to disclose.

 
 
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