Treatment of diagnosed ectopic pregnancy includes medical management with intramuscular methotrexate surgical management via salpingostomy or salpingectomy and in rare cases expectant management a patient with diagnosed ectopic pregnancy should be immediately transferred for surgery if she has peritoneal signs or hemodynamic instability if the initial beta human chorionic gonadotropin level is high if fetal cardiac activity is detected outside of the uterus on ultrasonography or if . Ectopic pregnancy should be considered in any patient presenting early in pregnancy with vaginal bleeding or lower abdominal pain in whom intrauterine pregnancy has not yet been established the. The diagnosis of ectopic pregnancy requires differentiating it from a viable intrauterine pregnancy this is done with the use of human chorionic gonadotropin levels hcg transvaginal ultrasound and in some cases uterine curettage although progesterone levels are typically higher in intrauterine gestations compared with ectopic gestations and a progesterone level of less than 5 ng ml can rule out a viable pregnancy there is not a definitive value that demarcates the two. An ectopic pregnancy occurs when a fertilised ovum implants outside the normal uterine cavity1 3 it is a common cause of morbidity and occasionally of mortality in women of reproductive age the aetiology of ectopic pregnancy remains uncertain although a number of risk factors have been identified4 its diagnosis can be difficult in current practice in developed countries diagnosis relies on a combination of ultrasound scanning and serial serum beta human chorionic gonadotrophin
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