Ectopic pregnancy in adolescents.
OBJECTIVE
Ectopic pregnancy continues to be an important cause of morbidity and mortality in women. Tubal damage is the likely cause of ectopic pregnancy. Healthcare providers who care for adolescents must screen for and treat sexually transmitted diseases like Chlamydia in order to decrease the risk of tubal damage and ectopic pregnancy. Smoking is a risk factor for ectopic pregnancy and teens should be encouraged to never start smoking or to quit if they already do smoke. Though ectopic pregnancy is more likely to occur in adults, teens are at risk as well, and early diagnosis allows for the possibility of conservative management.


RESULTS
Any teen who presents with amenorrhea, pain, or vaginal bleeding should be evaluated for a possible ectopic pregnancy. Adolescents are more likely to present with pain than adults. Transvaginal ultrasound should be performed and if an intrauterine pregnancy or ectopic pregnancy is not clearly seen, correlation with serum beta-human chorionic gonadotropin levels is done. If the beta-human chorionic gonadotropin level is above the 'discriminatory zone' of 1500 mIU and the transvaginal ultrasound does not show an intrauterine pregnancy, ectopic pregnancy should be suspected.


CONCLUSIONS
Unruptured ectopic pregnancy may be treated with expectant management, surgical management, or medical management (methotrexate). Healthy teens with unruptured ectopic pregnancies and who are able and willing to undergo close surveillance may be treated with methotrexate. There are case reports of successful treatment of ectopic pregnancy with methotrexate in adolescents.
Vichnin
Michelle
M
Department of Obstetrics and Gynecology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA. michelle_vichnin@merck.com
D000293:Adolescent; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000378:metabolism; D003267:Contraception; D003270:Contraceptive Agents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008727:Methotrexate / Q000494:pharmacology; D017063:Outcome Assessment, Health Care; D011247:Pregnancy; D011248:Pregnancy Complications; D011256:Pregnancy Outcome; D011271:Pregnancy, Ectopic / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control*; D012306:Risk; D012307:Risk Factors
D018997:Chorionic Gonadotropin, beta Subunit, Human; D003270:Contraceptive Agents; D008727:Methotrexate