The recent development and application of non-invasive diagnostic algorithms, utilizing transvaginal sonography and serum human chorionic gonadotrophin (hCG) assays, has facilitated earlier diagnosis of ectopic pregnancy. Consequently, this has increased the likelihood of an ectopic pregnancy being unruptured at diagnosis, thus allowing a greater diversity of management options as well as reducing the mortality and morbidity associated with the condition. Debate remains as to whether surgical, medical (methotrexate) or expectant treatment should be first line for the treatment of the asymptomatic woman with an unruptured ectopic pregnancy. This review aims critically to evaluate the diagnostic and treatment modalities currently available for ectopic pregnancy. Emphasis is placed on evaluating treatment success (e.g. cure rate, repeat treatment for persistent trophoblast, tubal patency) and long-term reproductive outcome (e.g. subsequent pregnancy rate and ectopic pregnancy recurrence) for each treatment method.
ABSTRACT