Incidence: 1/100 to 1/400 in 1985 in USA.

Etiology: 1/3 of ectopic embryo have abnormal karyotype PID (salpingitis), tubal reconstructive surgery(2-7%), conservative surgical management of ectopic pregnancy(10-20%), use of IUD (3-4% if pregnant), ?increasing use of ovulation-inducing agents (CC, hMG), IVF & ET, GIFT, DES exposure, tubal sterilization.
Types: 95% are tubal preg. (most in ampullary portion). ?other 5% in abdomen, ovay, cervix and retroperitoneum.

Diagnosis: Symptoms and signs: abdominal pain, vaginal spotting

Culdocentesis.

Serial b-hCG level: 1200 to 1500 mIU/ml IRP at 5-51/2 wks. Normal doubling times (2.5 days): 90% pregnancy. Lower levels in doubling times: 95% miscariage or ectopic. Higher levels : heterotopic pregnancy.(1/30,000), GTD.

Progesterone: in early preg. below 15 ng/ml indicated abnormal pregnacy. Found in 80% of ectopic preg. & 90% intrauterine preg.

Ultrasound: A central hypoechoic area surrounded by an echogenic rim of trophoblast or muscle. TV-sona can detect 1-3 cm range at the level of hCG between 800- 1000mIU/ml.

D&C: absence of villi.

Laparoscopy.

Mortality: 0.4%