**2. Ectopic pregnancy**

Ectopic pregnancy is one in which the conceptus implants outside the normal endometrial lining of the uterus, with the vast majority, over 95%, occurring in the fallopian tube [1]. It is a life-threatening gynaecological emergency and a leading cause of maternal morbidity and mortality in the early half of pregnancy [2], [3].

The incidence of ectopic pregnancy is increasing worldwide [4], and reported incidence varies from 1:60 to 1:250 pregnancies, and is dependent on the incidence of genital tract pathology and contraceptive practices of the population studied [5].

Delay in the diagnosis of ectopic pregnancy can be catastrophic because of the associated haemorrhage. Ectopic pregnancy should always be ruled out when a woman in the reproduc‐ tive age bracket presents with a missed period and abdominal pain.

There should be a high index of suspicion for early intervention and reduction of morbidity and mortality [6]. The presentation could be acute or chronic. Patients usually present with lower abdominal pain and minimal vaginal bleeding after 5-8 weeks period of amenorrhoea. There could also be shoulder tip pain and fainting spells if intraperitoneal bleeding is massive.

It is mandatory that patients with ectopic pregnancy be managed in a hospital. Sensitive pregnancy test and ultrasonography, preferably a transvaginal scan, aid in initial diagno‐ sis. Laparoscopy may also be used to diagnose ectopic pregnancy, but fails to detect early ectopic pregnancies or those obscured by adhesion. Diagnostic mini-laparotomy comes into play here.

Expectant or medical management of ectopic pregnancy should be considered in selected cases, but they are not widely practiced [7]. Some ectopic pregnancies resolve spontaneously, and this is the basis for expectant management. Methotrexate is employed for medical management in patients with unruptured ectopic pregnancy who are haemodynamically stable [8].

Surgery remains the mainstay of treatment of ectopic pregnancy. Surgical management is carried out by laparoscopy (Fig. 1) or laparotomy. For tubal pregnancy surgery may be radical (salpingectomy) or conservative (usually salpingostomy). For patients with ruptured ectopic pregnancy, especially those who present late, resuscitation and emergency laparotomy and salpingectomy are often required [9].

Patients managed for ectopic pregnancy require counselling because of the risk of recurrence, which is up to 20.5%, and such cases often give rise to diagnostic dilemma, especially when it occurs in an ipsilateral location [10]. Misdiagnosis of ectopic pregnancy may lead to dire consequences and an increase in case fatality [11, 12].

#### Overview of Gynaecological Emergencies http://dx.doi.org/10.5772/59107 35

**Figure 1.** Laparoscopy equipment.
