The diagnosis and management of ectopic pregnancy & pregnancy of unknown location

An ectopic pregnancy (EP) is any pregnancy implanted outside of the endometrial cavity. Pregnancy of unknown location (PUL) refers to inability to confirm the site of pregnancy despite a positive pregnancy test (1). Tubal pregnancy accounts for the majority of ectopic pregnancies and the incidence have increased with introduction and propagation of in-vitro fertilization (2). Smoking, alcohol consumption, initiation of oral contraceptives prior to the age of 16 years, and tubal ligation are among the famous risk factors of ectopic pregnancy (3). The overall incidence of ectopic pregnancy is about 10/1000 pregnancy. The incidence of ectopic pregnancy in women attending early antenatal clinics reaches 2-3%. Ectopic pregnancy is still an important cause of maternal mortality. It accounts for the majority of first trimester maternal deaths. Fortunately, mortality and long-term morbidity due to ectopic pregnancy has decreased over recent years, due to improved diagnosis and treatment modalities (4). In Egypt, the prevalence of EP was 0.52%, 0.62%, and 0.72% in 2018, 2019, and 2020, respectively. Risk factors of EP were grand multigravidity (55.2%), history of abortion (43.3%), history of pelvic inflammatory diseases (40%), history of abdominal and pelvic surgery (22.60%), history of infertility (19.1%), history of ART (16.5%), failure of IUCD (13.3%), history of previous EP (9.2%), and history of more than 3 CS deliveries (5.8%) (5).