Early diagnosis and appropriate treatment of the different types of ectopic pregnancies is essential in further reducing the number of women who lose their lives from the condition, states a revised guideline published today (4 November) by the Royal College of Obstetricians and Gynaecologists (RCOG) and the Association of Early Pregnancy Units (APEU).
An ectopic pregnancy is a pregnancy that grows outside the womb. In the UK, one in 90 pregnancies result in an ectopic pregnancy, with an estimated 11,000 ectopic pregnancies diagnosed each year. Most ectopic pregnancies occur in the fallopian tubes, however, 3-5 out of 100 ectopic pregnancies occur in other places such as the cervix or neck of the womb, ovary or abdomen. A pregnancy is unlikely to survive in these situations and can put the woman’s life at risk. Six maternal deaths were reported between 2006 and 2008 but the number of deaths has decreased over recent years, suggesting that earlier diagnosis and treatment may have made an impact.
Risk factors for ectopic pregnancy include a previous ectopic pregnancy, tubal damage following surgery or infection, an intrauterine device, the progesterone-only pill, smoking, advanced maternal age and IVF. However, the majority of women with an ectopic pregnancy have no identiﬁable risk factor.
The guideline provides evidence-based information on the diagnosis and management of ectopic pregnancies, including the surgical, pharmacological or conservative treatment options available and the level of support that should be offered to women. It also states that, in the absence of a history of subfertility or tubal pathology, there is no difference in the rate of fertility, the risk of future tubal ectopic pregnancy or tubal patency rates, between the different management methods. This is welcome news for women who have experienced an ectopic pregnancy and are worried about their fertility prospects.
Ms Janine Elson, lead author of the guideline and spokesperson for the Royal College of Obstetricians and Gynaecologists (RCOG), said:
“Ectopic pregnancies can be life threatening so it is important women seek help immediately if they are experiencing symptoms. Any woman of childbearing age who is having sex, could have an ectopic pregnancy.
“An ectopic pregnancy is a very personal experience, and the psychological impact can be very significant. It can mean coming to terms with the loss of a baby, with the potential impact on future fertility, or with the realisation that a woman could have lost her life.
“Each woman copes in her own way, but it is important that she feels supported. The guidelines reinforce that women undergoing treatment should be made aware of how to access support via patient support groups, such as the Ectopic Pregnancy Trust, or local bereavement counselling services.”
Mr Edward Morris, RCOG Vice President for Clinical Quality, said:
“We hope this guideline will support healthcare professionals in correctly diagnosing ectopic pregnancies and offering treatment options to women, who should be advised, whenever possible, of the advantages and disadvantages associated with each approach. The updated patient information that accompanies the guideline will also help women to better understand an ectopic pregnancy and the choices they have, should they be faced with this situation.”
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New patient information ‘Ectopic pregnancy’ is also published today.
This guideline replaces The Management of Tubal Pregnancy, which was published in 2004.