be pregnant, and think about offering a pregnancy test even when symptoms are non-specific and and Ectopic pregnancy and miscarriage: diagnosis and initial management (NG126) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 8 of 33the symptoms and signs of ectopic pregnancy can resemble the common symptoms and signs of other conditions – for example, gastrointestinal conditions or urinary tract infection. [2012] [2012 (...) Ectopic pregnancy and miscarriage: diagnosis and initial management Ectopic pregnancy and miscarriage: Ectopic pregnancy and miscarriage: diagnosis and initial management diagnosis and initial management NICE guideline Published: 17 April 2019 nice.org.uk/guidance/ng126 © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-conditions#notice-of- rights).Y Y our responsibility our responsibility The recommendations in this guideline represent the view

Ectopic pregnancy Ectopic pregnancy - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Ectopic pregnancy Last reviewed: February 2019 Last updated: October 2018 Summary Typically presents 6-8 weeks after last normal menstrual period, but can present earlier or later. Risk increases with prior ectopic pregnancy, tubal surgery, history of sexually transmitted infections, smoking, in vitro fertilisation, or if pregnant (...) of referred pain from intraperitoneal blood. Definition A fertilised ovum implanting and maturing outside of the uterine endometrial cavity, with the most common site being the fallopian tube (97%), followed by the ovary (3.2%) and the abdomen (1.3%). Bouyer J, Coste J, Fernandez H, et al. Sites of ectopic pregnancy: a 10 year population-based study of 1800 cases. Hum Reprod. 2002 Dec;17(12):3224-30. http://humrep.oxfordjournals.org/content/17/12/3224.full http://www.ncbi.nlm.nih.gov/pubmed/12456628?tool

secondary to ascending pelvic infection, and prior pelvic or fallopian tube surgery (3, ). Among women who become pregnant through the use of assisted reproductive technology, certain factors such as tubal factor infertility and multiple embryo transfer are associated with an increased risk of ectopic pregnancy ( , ). Women with a history of infertility also are at increased risk of ectopic pregnancy independent of how they become pregnant (7). Other less significant risk factors include a history (...) instability or an acute abdomen, should be evaluated and treated urgently. Early diagnosis is aided by a high index of suspicion. Every sexually active, reproductive-aged woman who presents with abdominal pain or vaginal bleeding should be screened for pregnancy, regardless of whether she is currently using contraception ( , ). Women who become pregnant and have known significant risk factors should be evaluated for possible ectopic pregnancy even in the absence of symptoms. Transvaginal Ultrasonography

Injectable methotrexate and ectopic pregnancy. An alternative to surgery, but patients must be made aware of the risks Prescrire IN ENGLISH - Spotlight ''Injectable methotrexate and ectopic pregnancy. An alternative to surgery, but patients must be made aware of the risks'', 1 February 2018 {1} {1} {1} | | > > > Injectable methotrexate and ectopic pregnancy. An alternative to surgery, but patients must be made aware of the risks Spotlight Every month, the subjects in Prescrire’s Spotlight. 100 (...) most recent :  |   |   |   |   |   |   |   |   |  Spotlight Injectable methotrexate and ectopic pregnancy. An alternative to surgery, but patients must be made aware of the risks FEATURED REVIEW For some women with an ectopic pregnancy, intramuscular injection of methotrexate can be an alternative to surgery. But methotrexate carries the risks of a cytotoxic drug, and is teratogenic: women treated with methotrexate should wait

Ectopic pregnancy Ectopic pregnancy - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Ectopic pregnancy Last reviewed: February 2019 Last updated: October 2018 Summary Typically presents 6-8 weeks after last normal menstrual period, but can present earlier or later. Risk increases with prior ectopic pregnancy, tubal surgery, history of sexually transmitted infections, smoking, in vitro fertilisation, or if pregnant (...) of referred pain from intraperitoneal blood. Definition A fertilised ovum implanting and maturing outside of the uterine endometrial cavity, with the most common site being the fallopian tube (97%), followed by the ovary (3.2%) and the abdomen (1.3%). Bouyer J, Coste J, Fernandez H, et al. Sites of ectopic pregnancy: a 10 year population-based study of 1800 cases. Hum Reprod. 2002 Dec;17(12):3224-30. http://humrep.oxfordjournals.org/content/17/12/3224.full http://www.ncbi.nlm.nih.gov/pubmed/12456628?tool

[ ]: Intrauterine contraception — the overall risk of ectopic pregnancy with the copper intrauterine device (Cu-IUD) or the levonorgestrel intrauterine system (LNG-IUS) is very low, but if a woman becomes pregnant with the device in situ, the risk of ectopic pregnancy is about 1 in 20 [ ]. Progestogen-only pill (POP) — there is a small increased risk of ectopic pregnancy in women using the POP, but the absolute risk is lower than if not using contraception. Around 1 in 10 pregnancies that occur may be ectopic (...) culture and fewer embryos being transferred [ ; ]. The incidence of heterotopic pregnancy (when both an intrauterine and an ectopic pregnancy are present) varies (by article and decade) from 1 in 4000 women to 1 in 30,000 women in the general population [ ; ]. In women pregnant as a result of assisted conception, the reported incidence is 1–3% [ ; ]. There have been case reports of ectopic pregnancies occurring in women who have had a hysterectomy (both total and supracervical), but this is extremely

Clinical audit of ectopic pregnancy The aim of this study was to determine the risk factors of ectopic pregnancy in cases presented to the Woman's Health Hospital (WHH) in Assuit University, and to perform clinical audit on strategies for management of ectopic pregnancy in the WHH.This descriptive hospital based study was conducted at the Woman's Health Hospital (WHH) of Assuit University (Egypt). There were 210 patients who were admitted to the WHH with the diagnosis of ectopic pregnancy (...) in the period between February 1, 2015 through the end of October 2015. Data were analyzed by SPSS version 21, using descriptive statistics, Mann-Whitney U test, and Chi square.Ectopic pregnancy affects woman in the reproductive age. There are many risk factors that increase the chance of its occurrence; however, it may also occur in the absence of any risk factors (14.0%). Internal VD (72.5%) is the most frequent risk factor; other risk factors include history of abortion, previous CS, ovulation induction

Ectopic pregnancy

Flowchart: Ectopic pregnancy Queensland Health State of Queensland (Queensland Health) 2018 http://creativecommons.org/licenses/by-nc-nd/3.0/au/deed.en Queensland Clinical Guidelines, Guidelines@health.qld.gov.au Queensland Clinical Guidelines www.health.qld.gov.au/qcg Ectopic pregnancy Queensland Clinical Guidelines: Early pregnancy loss. Flowchart version: F17.29-3-V5-R22 ß-hCG: human chorionic gonadtrophin, ELFT: electrolyte & liver function test, EPAS: Early Pregnancy Assessment Service (...) , FBC: full blood count, GP: General Practitioner, GTD: gestational trophoblast disease, IMI: intramuscular injection, IU/L: international units per litre, IUP: intrauterine pregnancy, IVI: intravenous injection, MFM: maternal fetal medicine, POC: products of conception, PUL: pregnancy of unknown location, PV: per vaginam, QTC: Queensland Trophoblast Centre, RhD-Ig: RhD immunoglobulin, TVS: transvaginal scan, USS: ultrasound scan, >: greater than, 5000 IU/L • Ectopic > 3 cm on TVS • Fetal heart

Aberrant expression of interleukin-6 and its receptor in Fallopian tubes bearing an ectopic pregnancy with and without tubal cytomegalovirus infection Cytomegalovirus (CMV) has recently been suggested as a potential risk factor for the development of ectopic pregnancy (EP) following upper genital tract infection in women. However, little is known about its associated underlying pathogenic mechanisms. This was a prospective case-control study that measured the prevalence of CMV infection

Bleeding and pain in early pregnancy (Ectopic pregnancy, Miscarriage, PUL)

Diagnosis and Management of Ectopic Pregnancy Diagnosis and Management of Ectopic Pregnancy - 2016 - BJOG: An International Journal of Obstetrics & Gynaecology - Wiley Online Library

The Diagnosis of Ectopic Pregnancy Systematic Review Snapshot TAKE-HOME MESSAGE Transvaginal sonography should be used in conjunction with quantitative serum b-hCG testing to rule out ectopic pregnancy in hemodynamically stable patients. No single level of b-hCG can be used in isolation to rule out ectopic pregnancy. The Diagnosis of Ectopic Pregnancy EBEM Commentator Lisa T. Barker, MD University of Illinois College of Medicine at Peoria/OSF St. Francis Medical Center Peoria, IL Shelly Zhou (...) , MD Medical University of South Carolina Charleston, SC Results Table. Findings supporting the diagnosis of ectopic pregnancy. Finding LR (D) 95% CI LR (–) 95% CI Abdominal pain with cough or light palpation 4.2–4.5 * 0.78–0.81 * Bimanual examination Cervical motion tenderness 4.9 1.7–14 0.62 0.47–0.83 Palpated adnexal mass 2.4 1.6–3.7 0.94 0.87–1.0 Transvaginal sonography (þ) adnexal mass, absent IUP 111 (12–1,208) 0.12 (0.03–0.55) IUP, Intrauterine pregnancy. *Finding only included in 2 studies

Inexscreen as a screening test for ectopic pregnancy and miscarriage Inexscreen as a screening test for ectopic pregnancy and miscarriage Inexscreen as a screening test for ectopic pregnancy and miscarriage Malaysian Health Technology Assessment (MaHTAS) Record Status This is a bibliographic record of a published health technology assessment from a member of INAHTA. No evaluation of the quality of this assessment has been made for the HTA database. Citation Malaysian Health Technology (...) Assessment (MaHTAS). Inexscreen as a screening test for ectopic pregnancy and miscarriage. Putrajaya: Malaysian Health Technology Assessment (MaHTAS). 2014 Authors' objectives To assess the safety, effectiveness (diagnostic accuracy) and cost-effectiveness of Inexscreen as a screening tool for ectopic pregnancy and miscarriage. Authors' conclusions There was limited retrievable fair level of evidence on the safety and effectiveness (diagnostic accuracy) of Inexscreen as a screening test for ectopic

Randomised controlled trial: Salpingectomy for tubal ectopic pregnancy is appropriate in the presence of healthy-looking contralateral tube Salpingectomy for tubal ectopic pregnancy is appropriate in the presence of healthy-looking contralateral tube | BMJ Evidence-Based Medicine We use cookies to improve our service and to tailor our content and advertising to you. You can manage your cookie settings via your browser at any time. To learn more about how we use cookies, please see our . Log (...) in using your username and password For personal accounts OR managers of institutional accounts Username * Password * your user name or password? Search for this keyword Search for this keyword Main menu Log in using your username and password For personal accounts OR managers of institutional accounts Username * Password * your user name or password? You are here Salpingectomy for tubal ectopic pregnancy is appropriate in the presence of healthy-looking contralateral tube Article Text Therapeutics

Does this woman have an ectopic pregnancy? The rational clinical examination systematic review Untitled Document The CRD Databases will not be available from 08:00 BST on Friday 4th October until 08:00 BST on Monday 7th October for essential maintenance. We apologise for any inconvenience.

in the ampullarysegmentofthetube(5). RISKFACTORS Any pregnant woman potentially can have an ectopic pregnancy. Damage to the fallopian tubes predisposes a woman to ectopic pregnancy. Knowl- edge of risk factors can help identify women who may bene?t from close monitoring and early treatment. High- risk conditions include [1] previous ectopic pregnancy; [2] history of tubal surgery, including a previous tubal sterilization; [3] history of sexually transmitted infection, tubal infection, or pelvic adhesions; [4] current use (...) Medical treatment of ectopic pregnancy: a committee opinion Medical treatment of ectopic pregnancy: a committee opinion The Practice Committee of the American Society for Reproductive Medicine American Society for Reproductive Medicine, Birmingham, Alabama Methotrexate,afolicacidantagonist,isaneffectivetreatmentforearlyunrupturedectopicpregnancy.Severaltreatmentregimensare available. Methotrexate is more effective when used to treat ectopic pregnancies with lower human chorionic gonadotropin

of 39they may be pregnant, and think about offering a pregnancy test even when symptoms are non-specific and and the symptoms and signs of ectopic pregnancy can resemble the common symptoms and signs of other conditions – for example, gastrointestinal conditions or urinary tract infection. All healthcare professionals involved in the care of women of reproductive age should have access to pregnancy tests. Using ultrasound for diagnosis Offer women who attend an early pregnancy assessment service (or out (...) Ectopic pregnancy and miscarriage: diagnosis and initial management Ectopic pregnancy and miscarriage: Ectopic pregnancy and miscarriage: diagnosis and initial management diagnosis and initial management Clinical guideline Published: 12 December 2012 nice.org.uk/guidance/cg154 © NICE 2018. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-conditions#notice-of- rights).Y Y our responsibility our responsibility The recommendations in this guideline represent

Laparoscopic Management of Tubal Ectopic Pregnancy 1 of5 Royal College of Obstetricians and Gynaecologists Consent Advice No. 8 June 2010 LAPAROSCOPIC MANAGEMENT OF TUBAL ECTOPIC PREGNANCY This is the first edition of this guidance. This paper provides advice for clinicians in obtaining consent of women undergoing laparoscopic salpingectomy or salpingotomy for ectopic pregnancy. This paper is intended to be appropriate for a number of procedures and combinations and the consent form should (...) to RCOG Green-top guideline No. 21 The Management of Tubal Pregnancy 2 and RCOG Patient Information An ectopic pregnancy: information for you. 3 The aim of this advice is to ensure that all women are given consistent and adequate information for consent; it is intended to be used together with dedicated patient information. After discharge, women should have clear direction for obtaining help if there are unforeseen problems. Clinicians should be prepared to discuss with the woman any of the points

. miscarriage and placenta praevia). Where bleeding occurs within the abdomen or uterus. This presents with little or no external loss, but pain and signs of hypovolaemic shock (e.g. ruptured ectopic pregnancy and placental CONCEALED abruption). REMEMBER, pregnant women may appear well even with a large amount of concealed blood loss. Tachycardia may not appear until 30% or more of the circulating volume has been depleted. NOTE: placental abruption may be a combination of revealed and concealed bleeding (...) pulse ABSENT – will normally need fluid replacement in the pregnant patient. At 20weeks 1 gestation The mother should be transferred immediately to the NEAREST OBSTETRIC UNIT. Transfer to further care must be preceded by a Hospital Alert Call via Control.Haemorrhage During Pregnancy (including miscarriage and ectopic pregnancy) Obstetrics and Gynaecological Emergencies October 2006 Page 3 of 3 Obstetrics & Gynaecological Emergencies Central pulse PRESENT, radial pulse PRESENT – DO NOT commence ?uid