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ACOG Issues Tubal Ectopic Pregnancy Guidelines

Obstet Gynecol; ePub 2017 Dec 6; ACOG

Laparoscopic surgery or intramuscular methotrexate administration are safe and effective treatments in clinically stable women in whom a nonruptured ectopic pregnancy has been diagnosed, according to new clinical management guidelines from the American College of Obstetricians and Gynecologists (ACOG). The guidelines offer a review of the information on the current understanding of tubal ectopic pregnancy and provide guidance for timely diagnosis and management. Among ACOG’s recommendations:

  • In clinically stable women in whom a nonruptured ectopic pregnancy has been diagnosed, laparoscopic surgery or intramuscular methotrexate administration are safe and effective treatment. (Level A)
  • The decision for surgical management or medical management of ectopic pregnancy should be guided by the initial clinical, laboratory, and radiologic data as well as patient-informed choice based on a discussion of the benefits and risk of each approach. (Level A)
  • Surgical management of ectopic pregnancy is required when a patient is exhibiting any of the following: hemodynamic instability, symptoms of an ongoing ruptured ectopic mass, or signs of intraperitoneal bleeding. (Level A)
  • Serum hCG values alone should not be used to diagnose an ectopic pregnancy and should be correlated with the patient’s history, symptoms, and ultrasound findings. (Level B)

Citation:

ACOG Committee on Practice Bulletins—Gynecology. Tubal Ectopic Pregnancy. Practice Bulletin No. 191. [Published online ahead of print December 6, 2017]. Obstet Gynecol. doi:10.1097/AOG.0000000000002464.

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