Rationale and impact

These sections briefly explain why the committee made the recommendations and how they might affect practice. They link to details of the evidence and a full description of the committee's discussion.

Using ultrasound for diagnosis of a tubal ectopic pregnancy

Recommendations 1.4.17 to 1.4.20

Why the committee made the recommendations

There was good evidence that, when seen on ultrasound, the presence of an adnexal mass with features of an early pregnancy (a gestational sac containing a yolk sac or fetal pole, with or without a heartbeat) was a reliable indicator for ectopic pregnancy.

Other features such as a complex inhomogeneous adnexal mass, adnexal mass with an empty gestational sac, empty uterus, a collection of fluid in the uterine cavity or free peritoneal fluid might indicate a suspicion of an ectopic pregnancy, but the evidence showed they are not reliable enough features on their own to diagnose an ectopic pregnancy. The committee used their knowledge and experience to recommend that other scan features, clinical presentation and serum human chorionic gonadotrophin (hCG) levels should therefore be used as well to confirm or rule out the diagnosis of ectopic pregnancy.

How the recommendations might affect practice

The recommendations will not change the amount of ultrasound scanning that is carried out but will standardise practice across the NHS. By defining the features that should be used to indicate the presence of an ectopic pregnancy, or a suspicion of an ectopic pregnancy (which can then be investigated further), the diagnosis of ectopic pregnancy should be improved and so risks to women will be reduced.

Full details of the evidence and the committee's discussion are in evidence review A: diagnostic accuracy of ultrasound features for tubal ectopic pregnancy.

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Management of tubal ectopic pregnancy

Expectant management

Recommendations 1.6.3 to 1.6.7

Why the committee made the recommendations

The evidence showed no significant differences in the number of ectopic pregnancies ending naturally, the need for additional treatment, the incidence of tubal rupture or the effect on health-related quality of life between expectant management and medical management, so the committee recommended that expectant management could be offered to clinically stable women with small ectopic pregnancies and low hCG levels, and should be considered for clinically stable women with small ectopic pregnancies and slightly higher hCG levels, as an alternative to medical management.

There was no evidence for the time taken for ectopic pregnancies to end naturally or the effects on future fertility but the committee agreed, based on their expertise and experience, that these outcomes were likely to be the same with expectant management compared with medical management.

How the recommendations might affect practice

These recommendations will standardise the management of ectopic pregnancy and make expectant management available for women when it is clinically appropriate. More women might have expectant management of ectopic pregnancy as a result. This could result in cost savings through a reduction in drug use and treatment of associated side effects. Local protocols will be needed for assessment, monitoring and follow-up of women choosing expectant management.

Full details of the evidence and the committee's discussion are in evidence review B: expectant versus medical management of tubal ectopic pregnancy.

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  • National Institute for Health and Care Excellence (NICE)