Introduction. Ectopic pregnancy is defined as the implantation of a
fertilized ovum outside the uterine cavity and it is one of the leading
causes of maternal morbidity and mortality. Localization and risk factors.
The most common localization of ectopic pregnancy is within the fallopian
tube, while other localizations include abdominal organs, ovaries, scars
after previous cesarean sections, and cervix. Risk factors for ectopic
pregnancy include previous fallopian tube injuries, infertility including
multiple embryo transfers, use of contraceptives, smoking, older age, prior
history of ectopic pregnancy, intentional abortions. Diagnostic procedures.
Measurement of serum beta-human chorionic gonadotropin levels along with
certain ultrasonography signs, i.e. extrauterine gestational sac, with a
present yolk sac and/or embryo, with or without a cardiac activity, have the
highest degree of reliability in making the diagnosis, whereas uncertain
signs, such as ?blob? and ?bagel? signs, also have a high positive
predictive value. Therapeutic modalities. Ectopic pregnancy can be treated
by surgical, medical or expectant management. Expectant and medical
management are reserved for hemodynamically stable patients who are
adequately informed and where monitoring and control are possible.
Conservative treatment. Before the initiation of treatment with
methotrexate, it is necessary to rule out a vital intrauterine pregnancy,
and consider the contraindications for methotrexate therapy, based on
detailed medical history and laboratory tests. The Clinic of Obstetrics and
Gynecology of the Clinical Center of Vojvodina uses a two-dose protocol by
which methotrexate is administered intramuscularly and which has proven to
be highly successful with few side effects. Surgical treatment modalities.
Candidates for emergency laparoscopy or laparotomy are women who are
hemodynamically unstable and who should not receive methotrexate.
Conclusion. In properly selected patients, the success rate of methotrexate
therapy is around 93%.