{"id":3298,"date":"2021-02-15T07:51:58","date_gmt":"2021-02-15T12:51:58","guid":{"rendered":"https:\/\/obgconnect.com\/library\/?p=3298"},"modified":"2025-01-15T21:41:09","modified_gmt":"2025-01-16T02:41:09","slug":"ectopic-pregnancy-treatment","status":"publish","type":"post","link":"https:\/\/obgconnect.com\/library\/2021\/02\/15\/ectopic-pregnancy-treatment\/","title":{"rendered":"Ectopic Pregnancy Treatment"},"content":{"rendered":"\n<ul class=\"wp-block-list\">\n<li><a href=\"#key-points\">Key Points<\/a><\/li>\n\n\n\n<li><a href=\"#background\">Background<\/a><\/li>\n\n\n\n<li><a href=\"#diagnosis\">Diagnosis<\/a><\/li>\n\n\n\n<li><a href=\"#treatment\">Treatment<\/a>\n<ul class=\"wp-block-list\">\n<li><a href=\"#expectant-management\">Expectant Management<\/a><\/li>\n\n\n\n<li><a href=\"#methotrexate\">Methotrexate<\/a><\/li>\n\n\n\n<li><a href=\"#contraindications\">Contraindications to MTX<\/a><\/li>\n\n\n\n<li><a href=\"#dosing\">Dosing<\/a><\/li>\n\n\n\n<li><a href=\"#surgical\">Surgical<\/a><\/li>\n\n\n\n<li><a href=\"#salpingostomy\">Salpingostomy<\/a><\/li>\n\n\n\n<li><a href=\"#cornual-pregnancy\">Cornual Pregnancy<\/a><\/li>\n\n\n\n<li><a href=\"#cervical-ectopic\">Cervical Ectopic<\/a><\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><a href=\"#primary-sources\">Primary Sources<\/a><\/li>\n\n\n\n<li><a href=\"#recommendations\">Professional Recommendations<\/a><\/li>\n\n\n\n<li><a href=\"#references\">References<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/obgconnect.com\/library\/2020\/03\/29\/labor-and-delivery-table-of-contents\/\"><strong>ObG L&amp;D<\/strong> Table of Contents<\/a><\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"key-points\">KEY POINTS: <\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Once a diagnosis of ectopic pregnancy has been made, a treatment plan must be generated.\n<ul class=\"wp-block-list\">\n<li>Per ACOG PB 193: \u201cIn 2011\u20132013, ruptured ectopic pregnancy accounted for 2.7% of all pregnancy-related deaths and was the leading cause of hemorrhage-related mortality\u201d<\/li>\n\n\n\n<li>Despite lay claims to the contrary, there is no surgical maneuver that can remove an ectopic and re-implant it in the uterus<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading background\">BACKGROUND:&nbsp;<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Tubal pregnancy accounts for approximately 2% (1 in 50) of reported pregnancies\u00a0<\/li>\n\n\n\n<li>The incidence of recurrence is approximately 15%; rises to 30% after (2) ectopics<\/li>\n\n\n\n<li>Over half of women diagnosed with ectopic pregnancy have no risk factors<\/li>\n\n\n\n<li>Among women presenting to the ER with first trimester bleeding and pain the incidence of ectopic pregnancy can be as high as 18% (ACOG PB193)<\/li>\n\n\n\n<li>Vaginal bleeding with an ectopic may be light, but the cause of massive hemorrhage and death is typically tubal rupture and intra-abdominal bleeding<\/li>\n\n\n\n<li>Surgical intervention is needed for the following\n<ul class=\"wp-block-list\">\n<li>Vital signs are unstable<\/li>\n\n\n\n<li>Hematoperitoneum is seen on imaging<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Rh Status\n<ul class=\"wp-block-list\">\n<li>Obtain blood type and Rh status on all women with suspected ectopic pregnancy<\/li>\n\n\n\n<li>All Rh-negative women with bleeding should receive RhO(D) immune globulin (RhoGam)<\/li>\n\n\n\n<li>Administer regardless of the final outcome of the pregnancy<\/li>\n\n\n\n<li>A 50mcg dose is appropriate for pregnancy loss &lt; 12w0d<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"diagnosis\">DIAGNOSIS:<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Evaluation of the pregnancy of unknown location and diagnosis of ectopic is covered in the \u2018Pregnancy of Unknown Location\u2019 chapter (see \u2018Related Topics\u2019 below)<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"treatment\">TREATMENT:&nbsp;<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"expectant-management\">Expectant Management<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Expectant management is not typically offered in the US<\/li>\n\n\n\n<li>However, in the UK, expectant management is permitted under certain clinical circumstances (NICE NG126)\n<ul class=\"wp-block-list\">\n<li>Patient stable and pain free<\/li>\n\n\n\n<li>Tubal ectopic measuring &lt;35 mm with no visible heartbeat<\/li>\n\n\n\n<li>hCG level \u22641000 IU\/L<\/li>\n\n\n\n<li>Can return for follow up<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li>UK NICE recommended expectant management follow-up: hCG measurements on days 2, 4 and 7 and look for 15% drop at each measurement\n<ul class=\"wp-block-list\">\n<li>If drop \u226515%: Draw hCG levels at weekly intervals to zero<\/li>\n\n\n\n<li>If drop &lt;15%: Alternate management should be undertaken<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Option in the UK guidance based on literature that, among appropriate candidates, did not show a difference between expectant and medical management for the following\n<ul class=\"wp-block-list\">\n<li>Rate of rupture or need for further treatment<\/li>\n\n\n\n<li>Future fertility and pregnancy outcomes<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Additionally, there is a small RCT (Jurkovic et al. Ultrasound Obstet Gynecol, 2017) that showed no difference in outcomes in women with hCG &lt;1500 at diagnosis between those treated with MTX or expectantly managed\n<ul class=\"wp-block-list\">\n<li>80 women were consented and randomized to 50mg\/m2 of MTX versus placebo injection<\/li>\n\n\n\n<li>Time to resolution was comparable between arms<\/li>\n\n\n\n<li>Resolution of pregnancy was 83% for methotrexate and 76% for placebo<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"methotrexate\">Methotrexate&nbsp;<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Determination of Pregnancy Location Prior to Methotrexate (MTX) Use\u00a0is important for many reasons\n<ul class=\"wp-block-list\">\n<li>Prevents\u00a0risk of birth defects from\u00a0accidental exposure of ongoing IUP\u00a0<\/li>\n\n\n\n<li>Limits MTX exposure to those patients who actually need it\u00a0<\/li>\n\n\n\n<li>Confirmation\/knowledge of true location may impact management of current and future pregnancies\u00a0<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Risk of waiting for MTX administration in Pregnancy of Unknown Location (PUL)\n<ul class=\"wp-block-list\">\n<li>Rupture of ectopic pregnancy while making the determination\u00a0<\/li>\n\n\n\n<li>Loss to follow-up<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Patients should be given strict precautions for return and signs of rupture\u00a0<\/li>\n\n\n\n<li>Consider MTX if following met\n<ul class=\"wp-block-list\">\n<li>Confirmed or high clinical suspicion of ectopic pregnancy\u00a0<\/li>\n\n\n\n<li>Hemodynamically stable\u00a0<\/li>\n\n\n\n<li>Unruptured mass\u00a0<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"contraindications\">Contraindications to MTX<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Absolute MTX Contraindications include\n<ul class=\"wp-block-list\">\n<li>Intrauterine pregnancy | Breastfeeding | Immunodeficiency | Blood dyscrasias | Clinically important hepatic\u00a0Dysfunction\u00a0| Active pulmonary disease | Active peptic ulcer disease | Clinically important renal dysfunction | Patient sensitive to MTX | Inability to participate in follow-up\u00a0<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Relative MTX Contraindications\n<ul class=\"wp-block-list\">\n<li>Gestational sac &gt; 4 cm (TV ultrasound) | High quantitative HCG (qHCG) | Positive fetal cardiac activity | Refusal to accept blood transfusion\u00a0<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>There is a risk of rupture or abortion with hematoperitoneum after treatment with MTX\n<ul class=\"wp-block-list\">\n<li>This risk appears to be low if patient is closely monitored.\u00a0<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"dosing\">Dosing<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Protocols can include single dose (most common), 2 dose, and multiple\u00a0dose\u00a0with\u00a0leukovorin\u00a0rescue doses\n<ul class=\"wp-block-list\">\n<li>Multiple\u00a0(3+)\u00a0dose protocols have not proven superior in studies\u00a0<\/li>\n\n\n\n<li>2\u00a0doses\u00a0have been shown to be superior to single dose\u00a0(Alur-Gupta et al. AJOG, 2019)\n<ul class=\"wp-block-list\">\n<li>Higher resolution of ectopic pregnancy\u00a0<\/li>\n\n\n\n<li>Superior in cases where hCG was higher or there was a visible adnexal mass (which are higher risk for treatment failure)\u00a0<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Can start with single dose and\u00a0re-dose\u00a0based on need\n<ul class=\"wp-block-list\">\n<li>MTX is dosed at 50mg\/m2 (based on patient height and weight)\u00a0<\/li>\n\n\n\n<li>LFTs and basic metabolic panel should be checked before administrating MTX\u00a0<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Typical monitoring protocol\n<ul class=\"wp-block-list\">\n<li>Check\u00a0hCG levels on days 0 (administration day), 4 and 7, then weekly if level continues to fall<\/li>\n\n\n\n<li>hCG level may rise on day 4 but this does not warrant retreatment<\/li>\n\n\n\n<li>By day 7, the hCG level should have fallen by 15% from day 4\u00a0(PPV of 93%; Kirk et al. Human Reproduction, 2007)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"surgical\">Surgical&nbsp;<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>If\u00a0pregnancy location is unknown\u00a0(and normally progressing IUP has been excluded)\n<ul class=\"wp-block-list\">\n<li>Can treat surgically by evacuating the uterine cavity and checking for villi to determine if there was an early IUP loss (incomplete AB)<\/li>\n\n\n\n<li>This can be done by floating products in water in Operating Room (if provider is experienced in determining this) <strong>or<\/strong> by frozen section by pathology<\/li>\n\n\n\n<li>If negative for villi then\u00a0can continue on to laparoscopy\u00a0(ACOG PB 193)\u00a0<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Surgical management of known tubal ectopic can include removal of the pregnancy from the tube (salpingostomy) or removal of the tube and pregnancy (salpingectomy)\u00a0<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"salpingostomy\">Salpingostomy<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Not shown to improve future fertility if the patient\u2019s other tube is present and appears normal\u00a0(Mol et al. Lancet, 2014)<\/li>\n\n\n\n<li>Could\u00a0theoretically\u00a0increase risk of future ectopic due to internal damage or previous\u00a0damage and\/or abnormality\n<ul class=\"wp-block-list\">\n<li>However, in the RCT by Mol et al (Lancet, 2014) this was not shown to be the case and confirmed in a meta-analysis of previous retrospective publications\u00a0<\/li>\n\n\n\n<li>Non-significant higher risk of continued trophoblastic tissue after surgery (Mol et al. Lancet, 2014)<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Typical monitoring protocol\n<ul class=\"wp-block-list\">\n<li>QHCG\u00a0should be checked at\u00a0post-operative\u00a0visit (4 to 6 weeks) for salpingostomy or patients whose tissue was aborted at the time of surgery and at risk for implantation in the peritoneal cavity<\/li>\n\n\n\n<li>Checking\u00a0qHCG at the 4 to 6-week visit for all surgically managed ectopic pregnancies is a valid protocol<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Surgical treatment of tubal pregnancy should be laparoscopic unless patient is too unstable or there is concern that hematoperitoneum is too large\u00a0<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"cornual-pregnancy\">Cornual Pregnancy<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Cornual pregnancy surgical treatment is higher risk for bleeding complications\n<ul class=\"wp-block-list\">\n<li>While sometimes able to be removed laparoscopically, patient should be counseled on high risk of conversion to open surgery\u00a0<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Cornual, abdominal and other ectopic pregnancies not in the tube should be managed by a provider with experience as they are at higher risk of complications and morbidity\/mortality<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"cervical-ectopic\">Cervical Ectopic<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>1 in 9000 pregnancies<\/li>\n\n\n\n<li>Tamponade with size 26-Foley catheter may be used to temporize bleeding (30cc)<\/li>\n\n\n\n<li>Methotrexate is first line for cervical ectopic<\/li>\n\n\n\n<li>Ligation of blood vessels: vaginal of cervical branches, uterine artery ligation or embolization of cervical, uterine or internal iliac arteries, usually in preparation for D&amp;C, or alongside chemotherapy.\u00a0 Limited data on fertility following UAE for cervical ectopic. Cervical artery ligation (3 and 9 o&#8217;clock with 2-0 vicryl) and tamponade.\u00a0<\/li>\n\n\n\n<li>Surgical excision usually involves curettage, but risks severe hemorrhage.\u00a0 Consider vasopressin prior to curettage (20 to 30 mL of vasopressin (0.5 units\/mL).\u00a0 Can consider primary hysterectomy if patient not desiring future fertility.\u00a0 In a review, 100% of cervical ectopic &gt; 12 weeks required hysterectomy<\/li>\n\n\n\n<li>Ultrasound guided intra-amniotic instillation of KCl (20-gauge needle with 1 to 5 mL of 20% KCl )solution and\/or methotrexate if FCA present; resorption can take 1-3 months<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"primary-sources\">PRIMARY SOURCES:<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">Hsu et al. AJOG, 2017<\/h3>\n\n\n\n<p>Retrospective Cohort Study of a Prospective Dataset&nbsp; (2006-2015) that assessed management trends and associations in ectopic pregnancy | 62,588 women were included<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Overall, 78.4% of women were treated surgically vs 21.6% who were treated with MTX<\/li>\n\n\n\n<li>From 2006-2015\n<ul class=\"wp-block-list\">\n<li>MTX use\u00a0increased from 14.5% to 27.3% (P&lt;.001)<\/li>\n\n\n\n<li>Salpingostomy decreased from 13.0% to 6.0% (P&lt;.001)<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Teaching hospital and higher volume centers were associated with the increased use of methotrexate (P&lt;.05)<\/li>\n\n\n\n<li>Medicaid recipients were less likely to receive MTX (adjusted risk ratio [ARR]\u00a00.92; 95% CI, 0.87 to 0.98)<\/li>\n\n\n\n<li>Uninsured women were less likely to receive MTX (ARR\u00a00.87; 95% CI, 0.82 to 0.93)<\/li>\n\n\n\n<li>Among those who underwent surgery, compared to white women, Black and Hispanic women were less likely to undergo salpingostomy\n<ul class=\"wp-block-list\">\n<li>Black women: ARR 0.76 (95% CI, 0.69 to 0.85)<\/li>\n\n\n\n<li>Hispanic women: ARR 0.80 (95% CI, 0.66 to 0.96)<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Among those who underwent surgery and were analyzed for insurance status, compared to commercial insurance\n<ul class=\"wp-block-list\">\n<li>Women with Medicaid were less likely to undergo salpingostomy ARR\u00a00.69 (95% CI, 0.64 to 0.75)<\/li>\n\n\n\n<li>Uninsured women were less likely to undergo salpingostomy ARR 0.60 (95% CI, 0.55 to 0.6)<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Conclusions\n<ul class=\"wp-block-list\">\n<li>The authors conclude that there are significant race and insurance related disparities in management of ectopic pregnancy<\/li>\n\n\n\n<li>However, the study did not assess outcomes and they were unable to compare clinical parameters at entry to care (such as weeks\u2019 gestation at presentation)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"recommendations\">PROFESSIONAL RECOMMENDATIONS:<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">ACOG PB 193<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>The recommendations in this chapter refer to treatment of ectopic pregnancy in a tubal location<\/li>\n\n\n\n<li>However, 90% of ectopic pregnancies are tubal and the ACOG Practice Bulletin states<\/li>\n<\/ul>\n\n\n\n<blockquote class=\"wp-block-quote is-layout-flow wp-block-quote-is-layout-flow\">\n<p>However, implantation in the abdomen (1%), cervix (1%), ovary (1\u20133%), and cesarean scar (1\u20133%) can occur and often results in greater morbidity because of delayed diagnosis and treatment<\/p>\n\n\n\n<p>An ectopic pregnancy can also co-occur with an intrauterine pregnancy, a condition known as heterotopic pregnancy<\/p>\n\n\n\n<p>The risk of heterotopic pregnancy among women with a naturally achieved pregnancy is estimated to range from 1 in 4,000 to 1 in 30,000, whereas the risk among women who have undergone in vitro fertilization is estimated to be as high as 1 in 100<\/p>\n<\/blockquote>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"references\">REFERENCES:<\/h2>\n\n\n\n<p><a href=\"https:\/\/www.acog.org\/clinical\/clinical-guidance\/practice-bulletin\/articles\/2018\/03\/tubal-ectopic-pregnancy\" target=\"_blank\" rel=\"noreferrer noopener\">ACOG Practice Bulletin 193: Tubal Ectopic Pregnancy<\/a><\/p>\n\n\n\n<p><a href=\"https:\/\/www.nice.org.uk\/guidance\/ng126\/chapter\/Recommendations\" target=\"_blank\" rel=\"noreferrer noopener\">NICE Guideline [NG126] Ectopic pregnancy and miscarriage: diagnosis and initial management<\/a><\/p>\n\n\n\n<p><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/27731538\" target=\"_blank\" rel=\"noreferrer noopener\">Single-dose systemic methotrexate vs expectant management for treatment of tubal ectopic pregnancy: a placebo-controlled randomized trial (Jurkovic et al. Ultrasound Obstet Gynecol, 2017)<\/a><\/p>\n\n\n\n<p><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/30629908\/\" target=\"_blank\" rel=\"noreferrer noopener\">Two-dose versus single-dose methotrexate for treatment of ectopic pregnancy: a meta-analysis (Alur-Gupta et al.&nbsp;AJOG,&nbsp;2019)<\/a><\/p>\n\n\n\n<p><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3963313\/\" target=\"_blank\" rel=\"noreferrer noopener\">Diagnosis and management of cervical ectopic. (Singh. J Hum Reprod Sci, 2013)<\/a><\/p>\n\n\n\n<p><a href=\"https:\/\/academic.oup.com\/humrep\/article\/22\/3\/858\/2939183\" target=\"_blank\" rel=\"noreferrer noopener\">A validation of the most commonly used protocol to predict the success of single-dose methotrexate in the treatment of ectopic pregnancy (Kirk et al. Human Reproduction, 2007)<\/a><\/p>\n\n\n\n<p><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/24499812\/\" target=\"_blank\" rel=\"noreferrer noopener\">Salpingotomy versus salpingectomy in women with tubal pregnancy (ESEP study): an open-label,&nbsp;multicentre,&nbsp;randomised&nbsp;controlled trial&nbsp;(Mol et al. Lancet, 2014)<\/a><\/p>\n\n\n\n<p><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/28288792\" target=\"_blank\" rel=\"noreferrer noopener\">Disparities in the management of ectopic pregnancy (Hsu et al. AJOG, 2017) <\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Once a diagnosis of ectopic pregnancy has been made, a treatment plan must be generated.<br \/>\nPer ACOG PB 193: \u201cIn 2011\u20132013, ruptured ectopic pregnancy accounted for 2.7% of all pregnancy-related deaths and was the leading cause of hemorrhage-related mortality\u201d<\/p>\n","protected":false},"author":6,"featured_media":3480,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[91],"tags":[87,86,84,83,85,82],"class_list":["post-3298","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-gyn","tag-abdominal-pregnancy","tag-cornual-pregnancy","tag-ectopic-pregnancy","tag-medical-management","tag-methotrexate","tag-surgical-treatment"],"acf":[],"featured_image_urls_v2":{"full":["https:\/\/obgconnect.com\/library\/wp-content\/uploads\/sites\/3\/2021\/01\/rodion-kutsaev-IJ25m7fXqtk-unsplash.jpg",400,265,false],"thumbnail":["https:\/\/obgconnect.com\/library\/wp-content\/uploads\/sites\/3\/2021\/01\/rodion-kutsaev-IJ25m7fXqtk-unsplash-150x150.jpg",150,150,true],"medium":["https:\/\/obgconnect.com\/library\/wp-content\/uploads\/sites\/3\/2021\/01\/rodion-kutsaev-IJ25m7fXqtk-unsplash-300x199.jpg",300,199,true],"medium_large":["https:\/\/obgconnect.com\/library\/wp-content\/uploads\/sites\/3\/2021\/01\/rodion-kutsaev-IJ25m7fXqtk-unsplash.jpg",400,265,false],"large":["https:\/\/obgconnect.com\/library\/wp-content\/uploads\/sites\/3\/2021\/01\/rodion-kutsaev-IJ25m7fXqtk-unsplash.jpg",400,265,false],"1536x1536":["https:\/\/obgconnect.com\/library\/wp-content\/uploads\/sites\/3\/2021\/01\/rodion-kutsaev-IJ25m7fXqtk-unsplash.jpg",400,265,false],"2048x2048":["https:\/\/obgconnect.com\/library\/wp-content\/uploads\/sites\/3\/2021\/01\/rodion-kutsaev-IJ25m7fXqtk-unsplash.jpg",400,265,false],"ultp_layout_landscape_large":["https:\/\/obgconnect.com\/library\/wp-content\/uploads\/sites\/3\/2021\/01\/rodion-kutsaev-IJ25m7fXqtk-unsplash.jpg",400,265,false],"ultp_layout_landscape":["https:\/\/obgconnect.com\/library\/wp-content\/uploads\/sites\/3\/2021\/01\/rodion-kutsaev-IJ25m7fXqtk-unsplash.jpg",400,265,false],"ultp_layout_portrait":["https:\/\/obgconnect.com\/library\/wp-content\/uploads\/sites\/3\/2021\/01\/rodion-kutsaev-IJ25m7fXqtk-unsplash.jpg",400,265,false],"ultp_layout_square":["https:\/\/obgconnect.com\/library\/wp-content\/uploads\/sites\/3\/2021\/01\/rodion-kutsaev-IJ25m7fXqtk-unsplash.jpg",400,265,false],"woocommerce_thumbnail":["https:\/\/obgconnect.com\/library\/wp-content\/uploads\/sites\/3\/2021\/01\/rodion-kutsaev-IJ25m7fXqtk-unsplash-300x265.jpg",300,265,true],"woocommerce_single":["https:\/\/obgconnect.com\/library\/wp-content\/uploads\/sites\/3\/2021\/01\/rodion-kutsaev-IJ25m7fXqtk-unsplash.jpg",400,265,false],"woocommerce_gallery_thumbnail":["https:\/\/obgconnect.com\/library\/wp-content\/uploads\/sites\/3\/2021\/01\/rodion-kutsaev-IJ25m7fXqtk-unsplash-100x100.jpg",100,100,true]},"post_excerpt_stackable_v2":"<p>Once a diagnosis of ectopic pregnancy has been made, a treatment plan must be generated.<br \/>\nPer ACOG PB 193: \u201cIn 2011\u20132013, ruptured ectopic pregnancy accounted for 2.7% of all pregnancy-related deaths and was the leading cause of hemorrhage-related mortality\u201d<\/p>\n","category_list_v2":"<a href=\"https:\/\/obgconnect.com\/library\/category\/labor-and-delivery\/gyn\/\" rel=\"category tag\">GYN Emergencies<\/a>","author_info_v2":{"name":"mharris","url":"https:\/\/obgconnect.com\/library\/author\/mharris\/"},"comments_num_v2":"0 comments","yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Ectopic Pregnancy Treatment - OBG LIBRARY<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/obgconnect.com\/library\/2021\/02\/15\/ectopic-pregnancy-treatment\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Ectopic Pregnancy Treatment - OBG LIBRARY\" \/>\n<meta property=\"og:description\" content=\"Once a diagnosis of ectopic pregnancy has been made, a treatment plan must be generated. 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