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The majority of ectopic pregnancies occur within the Fallopian tube, with most implanted in the ampullary region. A number of risk factors have been identified for ectopic pregnancy. Transvaginal ultrasound (TVU) has now become the diagnostic technique of choice for ectopic pregnancy. Historically, laparotomy with salpingectomy was the standard treatment for ectopic pregnancy. Laparoscopic surgery has been shown to be superior to laparotomy, making it the surgical approach of choice. A number of drugs have been used for the treatment of ectopic pregnancy including potassium chloride, prostaglandins, hyperosmolar glucose, mifepristone and actinomycin D. However, the most commonly used drug in clinical practice for the treatment of ectopic pregnancy is methotrexate. The reported success rates for expectant management range between 48-100%. Subsequent hysterosalpingography has shown patency for the affected tube in up to 93% of cases of ectopic pregnancy managed expectantly.
Sporadic early pregnancy loss occurs in approximately 15% of clinically recognised pregnancies. One of the most remarkable aspects of the first-trimester miscarriage of pregnancy is the fact that the majority of karyotypically abnormal pregnancies miscarry in the first trimester and the majority of karyotypically normal pregnancies continue. Comparative genomic hybridisation (CGH) can be used to analyse the cytogenetics of formalin-fixed, paraffin-embedded miscarriage specimens. The newly introduced medical therapeutic abortion methodology has allowed detailed examination of undamaged first-trimester pregnancies. The traditional 'gold standard' management for miscarriage was dilatation and surgical curettage of the uterus. This was initiated to prevent blood loss and infection. An alternative to surgical management with drugs has been developed since the early 1990s. Obtaining an accurate aetiology should be within the capabilities of all hospital clinics and is indispensable in informing and supporting the management of miscarriage.
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