Diagnostic Criteria in Extrauterine Pregnancy

Introduction Ectopic pregnancy is characterized by implantation of an embryo outside the uterine cavity and usually is located in the distal portion of the fallopian tube. The common triade of symptoms includes: abdominal pain, vaginal bleeding and amenorrhea. The ectopic pregnancy is still considered an important cause of death in the first trimester of pregnancy, for this reason a rapid and accurate diagnosis is considered the most important factor for reducing maternal morbidity and mortality and preserving the fertility. We reviewed published works that analyzed the common diagnostic methods classifying in four categories: clinical, biochemical, ultrasound and radiological and surgical diagnose. Actually, according to American College of Obstetricians and Gynecologists (ACOG) guidelines the most efficacious strategy to diagnose an ectopic pregnancy appears to be the combination of ultrasound, physical examination and biochemical tests. Citation: Cignini Pietro., et al. “Diagnostic Criteria in Extrauterine Pregnancy”. EC Gynaecology 1.1S1 (2016): 29-35. Ectopic pregnancy (EP) is characterized by the implantation of an embryo outside the uterine cavity with an incidence of about 1-2% of all pregnancies and causes about 4-6% of all pregnancy related deaths [1-3]. Early diagnosis and management improve the survival from 31.2 to 16.9/1000 maternities indeed the incidence remains the same [4]. In fact the rapid identification and accurate diagnosis of EP is considered an important factor to reduce maternal morbidity and mortality and preserving the future fertility. Regarding the site, in the 93-97% of cases of EP the site of implantation is the distal portion of the fallopian tube, less commonly the isthmic, infundibular and interstitial portions. Other extratubal sites include ovary, cervix, cornua, prior cesarean scar, interstitial and abdomen [5]. Most common factors for the pathogenesis of EP are the tubal damage, such as salpingitis, progressive loss of myoelectrical activity, deciliation of the tube, which cause an impairment of embryo transport in the tube. Other reasons include atrophy of endometrium with an increase in the level of progesterone and problems related to embryo development [6]. Several risk factors for EP have been identified and classified into three categories: high, moderate and low risk factors [7-9]. Previous tubal pregnancy, surgery, sterilization and pathology, and use of intrauterine device (IUD) are classified as high risk factors. Moderate risk includes infertility, pelvic inflammatory disease (PID), sexually transmitted diseases, in particular chlamydia related disease and gonorrhea, multiple sexual partners and smoking. History of pelvic or abdominal surgery, vaginal douching and an age < 18 represent low risk factors [7-10]. The common symptoms of EP are abdominal pain, vaginal bleeding and amenorrhea [11]. Thus, the aim of our review is to analyze a list of common diagnostic methods to identify earlier and more accurately EP.