Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Ectopic pregnancy: Expectant management

Togas Tulandi, MD, MHCM
Section Editor
Robert L Barbieri, MD
Deputy Editor
Sandy J Falk, MD, FACOG


Ectopic pregnancy is a gynecologic emergency, generally requiring expeditious surgical or medical treatment. However, in a small number of cases in which the risk of tubal rupture is minimal, expectant management is appropriate. Women who are candidates for expectant management of ectopic pregnancy require informed consent about the risks of this strategy and close observation until the pregnancy has resolved.

In a historic study, expectant management versus surgery in women with ectopic pregnancy, regardless of risk factors for tubal rupture, resulted in a 57 percent success rate [1]. However, most of the patients who failed this approach had significant complications (ie, tubal rupture) or ultimately required surgery for ongoing pregnancy.

Success rates of expectant management vary from 48 to 100 percent, depending in large part on differences in inclusion criteria [2].

Expectant management of ectopic pregnancy will be discussed here. Medical and surgical management of ectopic pregnancy are reviewed separately. (See "Ectopic pregnancy: Choosing a treatment and methotrexate therapy" and "Ectopic pregnancy: Surgical treatment" and "Abdominal pregnancy, cesarean scar pregnancy, and heterotopic pregnancy" and "Cervical pregnancy".)


Selection criteria — When ectopic pregnancy is suspected, in our practice, we employ expectant management only for patients who meet the following criteria: (1) transvaginal ultrasound (TVUS) does not show a gestational sac or demonstrate an extrauterine mass suspicious for an ectopic pregnancy and (2) the beta-human chorionic gonadotropin (hCG) concentration is low (≤200 mIU/mL) and declining [3]. This also the threshold advised by the American College of Obstetricians and Gynecologists (ACOG) [4]. We define a declining hCG level as lower at the third measurement than at the first measurement.


Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Sep 2016. | This topic last updated: Sep 17, 2015.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
  1. LUND J. Early ectopic pregnancy; comments on conservative treatment. J Obstet Gynaecol Br Emp 1955; 62:70.
  2. Kirk E, Condous G, Bourne T. The non-surgical management of ectopic pregnancy. Ultrasound Obstet Gynecol 2006; 27:91.
  3. Korhonen J, Stenman UH, Ylöstalo P. Low-dose oral methotrexate with expectant management of ectopic pregnancy. Obstet Gynecol 1996; 88:775.
  4. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 94: Medical management of ectopic pregnancy. Obstet Gynecol 2008; 111:1479.
  5. Trio D, Strobelt N, Picciolo C, et al. Prognostic factors for successful expectant management of ectopic pregnancy. Fertil Steril 1995; 63:469.
  6. van Mello NM, Mol F, Verhoeve HR, et al. Methotrexate or expectant management in women with an ectopic pregnancy or pregnancy of unknown location and low serum hCG concentrations? A randomized comparison. Hum Reprod 2013; 28:60.
  7. van Mello NM, Mol F, Adriaanse AH, et al. The METEX study: methotrexate versus expectant management in women with ectopic pregnancy: a randomised controlled trial. BMC Womens Health 2008; 8:10.
  8. Banerjee S, Aslam N, Zosmer N, et al. The expectant management of women with early pregnancy of unknown location. Ultrasound Obstet Gynecol 1999; 14:231.
  9. Tulandi T, Hemmings R, Khalifa F. Rupture of ectopic pregnancy in women with low and declining serum beta-human chorionic gonadotropin concentrations. Fertil Steril 1991; 56:786.
  10. van Mello NM, Mol F, Hajenius PJ, et al. Randomized comparison of health-related quality of life in women with ectopic pregnancy or pregnancy of unknown location treated with systemic methotrexate or expectant management. Eur J Obstet Gynecol Reprod Biol 2015; 192:1.
  11. Rantala M, Mäkinen J. Tubal patency and fertility outcome after expectant management of ectopic pregnancy. Fertil Steril 1997; 68:1043.
  12. Zohav E, Gemer O, Segal S. Reproductive outcome after expectant management of ectopic pregnancy. Eur J Obstet Gynecol Reprod Biol 1996; 66:1.
  13. Strobelt N, Mariani E, Ferrari L, et al. Fertility after ectopic pregnancy. Effects of surgery and expectant management. J Reprod Med 2000; 45:803.