If extrauterine pregnancy (EUG) is suspected, a gynecologist should always be consulted as soon as possible. How is such a pregnancy diagnosed outside the uterus? What are the treatment options? You can find out here.
Extrauterine pregnancy: how is the diagnosis made?
If pregnancy is known or periods have failed to occur and the above signs develop, a gynecologist should be consulted as soon as possible.
If there is a suspicion of EUG after asking the patient’s history and palpation (in which the uterus and/or abdomen may be painful), an ultrasound examination and an examination of blood and urine are first performed (especially a pregnancy test by determining beta-HCG and ruling out urinary tract infections).
Especially in early pregnancy, the findings are sometimes inconclusive; nevertheless, hospital admission is advised at the slightest suspicion.
What is the therapy?
The hospital approach depends on the symptoms and ranges from a wait-and-see approach with regular checkups to diagnostic and/or therapeutic laparoscopy to open surgery.
The risk of life-threatening complications for the pregnant woman is very high – extrauterine pregnancy is the most common cause of death of pregnant women during the first trimester of pregnancy, and still the fourth most common cause of death of women in connection with pregnancy and childbirth overall.
Therefore, a diagnosed extrauterine pregnancy is always terminated. Surgical and medicinal measures are mainly available for this purpose, and their benefits and risks are weighed against each other depending on the situation.
Surgery for extrauterine pregnancy
Surgery offers the options of removing only the fruit but preserving the fallopian tube (salpingotomy) or removing the affected fallopian tube (salpingectomy).
The first procedure increases the risk of another ectopic pregnancy and involves the risk of an oocyte remnant remaining (trophoblast persistence), which can later degenerate. Therefore, the second procedure is more commonly used in women with completed family planning.
In the case of ovarian pregnancy, an attempt is made to remove the fruit while preserving as much of the ovary as possible; sometimes the entire ovary must be removed. In cervical pregnancy, the entire uterus usually must be removed.
Medications for extrauterine pregnancy
Medications used to treat extrauterine pregnancy are:
- Methotrexate (MTX), a cytotoxin, which is otherwise used primarily for cancer and rheumatoid therapy
- Prostaglandins such as dinoprostone
- Antigestagens such as mifepristone
- Hyperosmolar glucose
They all lead to the death and expulsion of the fruit into the abdomen.
MTX is mainly used when there is an ectopic pregnancy without complications, as well as to support surgery, for example, to cause the egg remnant to die. Whether the treatment is effective is checked with the pregnancy hormone beta-HCG. For the other substances, experience to date is still very limited, especially as sole therapy.
The drugs are used primarily as blood infusions or muscle injections, and less frequently as tablets or local application (for example, injected into the fallopian tube during laparoscopy).
