Tubal ectopic pregnancies: Risk, diagnosis and management
Ectopic pregnancies are an important cause of morbidity and mortality in early pregnancy. This article presents an up-to-date review of the risk factors associated with tubal ectopic pregnancies and how these patients present. This is crucial for midwives who may be conducting booking appointments at earlier gestations and for those working in early pregnancy units. The role of transvaginal ultrasound as the new diagnostic gold standard is also explored. Management strategies are outlined, including the surge in conservative treatment, and the long term implications of ectopic pregnancies are also outlined. A case study is presented to show an example of how these women present in early pregnancy.
Ectopic pregnancy is defined as a pregnancy that has implanted at a site outside of the endometrial cavity. In 95% of cases, this will be in the fallopian tube (Elson et al, 2016). It was first described indirectly by Abulcasis in the late first century, but successful treatment was not documented until the late 1800s (Lurie, 1992). Its incidence in the UK has remained fairly stable over the last few decades at 11 in 1000 pregnancies (Rajkhowa et al, 2000); however, the incidence increases up to 3% in women presenting to early pregnancy units (Mavrelos et al, 2013). This increase highlights the importance and role of the early pregnancy unit and those working within it.
Ectopic pregnancy remains one of the main direct causes of maternal death. At a rate of 0.25 per 100 000 maternities, this is akin to eclampsia and pre-eclampsia (MBRRACE-UK, 2015). In lower resource countries, the mortality rate is up to ten times higher (Goyaux et al, 2003). It is therefore crucial that ectopic pregnancy is diagnosed and well managed, in order to avoid poor outcomes. The role of the midwife is important in this context, as they are often the first health professional to make contact with a woman when she is pregnant. An understanding of ectopic pregnancy is therefore essential for the midwife to help avoid morbidity and mortality.
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