Ectopic Pregnancy

Togas Tulandi, M.D., M.H.C.M.

In the 11th century, Albucasis, a surgeon of the Middle Ages, first mentioned ectopic pregnancy in his writings. He described fetal bones extruded from a suppurating sinus at the umbilicus. Subsequently, other cases were described; however, all of them resulted in death. Smith, a Canadian surgeon, appears to be the first surgeon to perform a successful surgery for ectopic pregnancy. He removed a gallon of blood from the peritoneal cavity (Lockyer, 1903).

Today, most ectopic pregnancies could be diagnosed in the early stage. However, a few women still come to the emergency department in shock with ruptured ectopic pregnancy. In fact, ectopic pregnancy is still the leading cause of pregnancy-related death in the first trimester.

In this issue of Seminars in Reproductive Medicine, experts discuss several features of ectopic pregnancy, from diagnosis to reproductive performance after ectopic pregnancy. Condous states that instead of relying on the absence of an intrauterine gestation, the diagnosis should be based on transvaginal visualization of an adnexal mass. With this technique, one could diagnose ectopic pregnancy in its early stage, allowing conservative management, including medical and minimally invasive surgical treatments.

Lipscomb discusses the indications and contraindications of systemic treatment. He reviews predictors of success and management of complications associated with methotrexate therapy. Jabre-Raughley and Frishman discuss local intratubal treatment of ectopic pregnancy with different substances, including the commonly used methotrexate and KCl. Al-Sunaidi and Tulandi review surgical treatment of tubal pregnancy as well as other types of ectopic pregnancy.

Molinaro and Barnhart remind us that the diagnosis and treatment of ectopic pregnancy still needs improvement. There are many reports of management of ectopic pregnancy at unusual sites. However, due to its low incidence, most authors published only case reports of a small number of patients. Creation of a registry of ectopic of unusual sites will help us to have a better understanding of this condition. An example of such registries is the registry on cervical pregnancy of the American Association for Gynecologic Laparoscopists and the Society of Reproductive Surgeons (http://www.aagl.org/registry/survey.asp). The purpose of this registry is to elucidate the risk factors and medical and surgical management of cervical pregnancy. Participation by all of us in the registry will facilitate a better understanding of ectopic pregnancy and its treatment.

Finally, Buster analyzes the reproductive performance after the most common treatments for ectopic pregnancy: laparoscopic salpingostomy, methotrexate, and expectant management. He concludes that due to the nonrandomized nature of the studies, concern for long-term reproductive performance should not be a factor in selecting a particular treatment.

I am grateful to the authors who have contributed to this issue of the Seminars in Reproductive Medicine. As they have stated, many facets of ectopic pregnancy remain unclear. The contributions in this issue will be valuable for practicing gynecologists, residents, and fellows. Readers will gain an understanding of diagnosis, and medical and surgical treatment of tubal and nontubal ectopic pregnancies. I hope that the materials in this issue will be helpful in directing new investigations and the clinical management of this condition.