Title: Key Elements in the Evaluation and Management Criteria of Ectopic Pregnancy

Abstract:

Ectopic pregnancy is a pregnancy that implants outside the endometrial cavity. The fallopian tube is the most common site for ectopic pregnancy. 95% of ectopic pregnancies typically occur in the fallopian tube. Other sites are ovary, cervix, and abdomen. Heterotopic pregnancy, which is defined as the presence of simultaneously gestations inside and outside of the uterine cavity, is historically rare.[1] The diagnosis of ectopic pregnancy is critical to reduce morbidity and mortality associated with this condition.[2] It has significant health consequences and is an important cause of morbidity and mortality for reproductive age women.[3] The incidence of ectopic pregnancy is about 1%-2% of all pregnancies reported in the developed world. These women are at risk for complications, such as organ rupture with massive bleeding, risk related treatment, recurrent ectopic pregnancy, and future infertility.[3] Risk factors include a history of chlamydia or gonorrheal infections, exposure to diethylstilbestrol, intrauterine device use, and assisted reproductive technology. However, 50% of women with an ectopic pregnancy do not have a risk factor. About 5% of women with ectopic pregnancy present in haemorrhagic shock. Pallor, tachycardia and hypotension. The common presentation of ectopic pregnancy occurs with vaginal bleeding and lower abdominal pain in a woman with delayed menses which also occurs in early pregnancy miscarriage. Clinical suspicion is the key to identifying women who need prompt and careful evaluation. Serial serum beta–human chorionic gonadotropin (β-HCG) levels is the criterion standard to differentiate between normal and abnormal pregnancies and to monitor resolution of ectopic pregnancy once therapy has been initiated. In almost 99% of viable first trimester intrauterine pregnancies, β-HCG values increase by at least 53% every 48 hours.[4] Ultrasonography is probably the most important tool for diagnosing an extrauterine pregnancy. An empty uterus on endovaginal ultrasonographic images in patients with a serum β-HCG level greater than the discriminatory cutoff value is an ectopic pregnancy until proven otherwise. A discriminatory zone of 1,500 to 3,000 mIU/mL is used most commonly.[4] The value of ultrasonography is highlighted further by its ability to demonstrate free fluid in the pouch of Douglas and Morison. After a definitive diagnosis of ectopic pregnancy has been made, treatment options include medical therapy with Methotrexate, surgery, or expectant management. The criteria for management of ectopic pregnancy are based on the general evaluation of the ectopic pregnancy through clinical features, sonographic assessment and serum Beta-hCG.[5] It is important that the purpose of each investigation is clearly explained and the treatment options are unambiguously outlined so that the woman and her partner may understand the treatment choices available to her. The choice of treatment is jointly agreed between the woman and the attending obstetrician.

Biography:

Lydia Charitopoulou is a consultant physician , a senior doctor by profession who practices in the medical speciality of gynecology and obstretics. Works with one of the State hospitals in the region of Frankfurt. She holds a training consulting rore in Obstretics and currently undertaking surgical, diagnostic and therapeutic cases in Gynecology Oncology. She is particular active in one of the leading certified Breast Centers in the federal State of Hessen in Germany. Lydia grew up in Athens, studied medicine in Czech Republic and Slovakia in a competitive international system. After short/time collection of medical training experience in one of the biggest