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Diagnosis and Management of Ectopic Pregnancy (Green-top Guideline No. 21)

Published: 04/11/2016

You can also access this guideline in PDF.

This guideline replaces The Management of Tubal Pregnancy, which was published in 2004.

This is a joint guideline by the RCOG and the Association of Early Pregnancy Units (AEPU).

The second edition of this guideline is currently in development.

An ectopic pregnancy is any pregnancy implanted outside of the endometrial cavity. In the UK, the incidence is approximately 11/1000 pregnancies, with an estimated 11 000 ectopic pregnancies diagnosed each year. This guideline will cover the following ectopic pregnancies: tubal, cervical, caesarean scar, interstitial, cornual, ovarian, abdominal and heterotopic. The diagnosis and management of pregnancy of unknown location will not be covered.

Unfortunately, women still die from ectopic pregnancy, with six maternal deaths reported between 2006 and 2008. However, the case fatality rate has decreased over recent years, suggesting that earlier diagnosis and treatment may have made an impact.

Risk factors for ectopic pregnancy include tubal damage following surgery or infection, smoking and in vitro fertilisation. However, the majority of women with an ectopic pregnancy have no identifiable risk factor.

Declaration of interests (guideline developers)

Ms CJ Elson FRCOG, London: Ms Elson is a medical advisor and volunteer for the Ectopic Pregnancy Trust.

Mr R Salim MRCOG, London: None declared.

Miss N Potdar MRCOG, Leicester: None declared.

Ms M Chetty MRCOG, Edinburgh: None declared.

Miss JA Ross FRCOG, London: Ms Ross is a medical advisor to the Ectopic Pregnancy Trust and a member of the Association of Early Pregnancy Units. She receives payments for running courses sponsored by Cook UK.

Ms EJ Kirk MRCOG, London: Ms Kirk is coordinator of the European Society of Human Reproduction and Embryology Special Interest Group in Implantation and Early Pregnancy, is on the executive committee of the Association of Early Pregnancy Units and is a medical advisor to the Ectopic Pregnancy Trust.

Elsewhere on the site

Consent advice for laparoscopic management of tubal pregnancy
Consent Advice No. 8 provides advice for clinicians on obtaining consent from women undergoing laparoscopic salpingectomy or salpingotomy for ectopic pregnancy

Patient information

Information for women about ectopic pregnancy