Abstract
Ectopic pregnancy (EP) or extra uterine pregnancy, accepted from the Greek word ‘‘ektopos’’ meaning out of place, refers to the blastocyst implantation outside the uterine cavity endometrium. The fallopian tube is the dominant site in the majority of cases of ectopic pregnancy. Approximately, 75% of deaths in the first trimester and 9% of all pregnancy-related deaths are due to EP. The etiology of EP is multifactorial. The postulated mechanism includes (1) anatomic obstruction, (2) abnormalities in tubal motility or ciliary function, (3) abnormal conceptus, and (4) chemotactic factors stimulating tubal implantation. The triad of pain, vaginal bleeding and amenorrhea was historically used to suspect a diagnosis of EP. The symptoms of EP are often non-specific and difficult to differentiate from those of other gynecological, gastrointestinal and urological disorders. The use of transvaginal scan (TVS) has changed the diagnostic approach to one based on visualizing the ectopic mass. TVS has been demonstrated to be superior to transabdominal ultrasound (TAS). Management options include expectant management, medical treatment, conservative surgery and radical surgery. With early diagnosis, most women with ectopic pregnancy could be treated with methotrexate (MTX). Currently, there are three main treatment regimens for management of ectopic pregnancy with methotrexate: the multidose protocol, the single-dose protocol, and the two-dose protocol.