Guideline No. 414: Management of Pregnancy of Unknown Location and Tubal and Nontubal Ectopic Pregnancies

J Obstet Gynaecol Can. 2021 May;43(5):614-630.e1. doi: 10.1016/j.jogc.2021.01.002. Epub 2021 Jan 13.


Objective: To provide an evidence-based algorithm to guide the diagnosis and management of pregnancy of unknown location and tubal and nontubal ectopic pregnancy.

Target population: All patients of reproductive age.

Benefits, harms, and costs: The implementation of this guideline aims to benefit patients with positive β-human chorionic gonadotropin results and provide physicians with a standard algorithm for expectant, medical, and surgical treatment of pregnancy of unknown location and tubal pregnancy and nontubal ectopic pregnancies.

Evidence: The following search terms were entered into PubMed/Medline and Cochrane in 2018: cesarean section, chorionic gonadotropin, beta subunit, human/blood, fallopian tubes/surgery, female, fertility, humans, infertility, laparoscopy, methotrexate, methotrexate/administration & dosage, methotrexate/therapeutic use, pregnancy (abdominal, angular, cervix, cornual, ectopic, ectopic/diagnosis, ectopic/diagnostic imaging, ectopic/drug therapy, ectopic/epidemiology, ectopic/mortality, ectopic/surgery, heterotopic, interstitial, isthmo-cervical, ovarian, tubal, unknown location), recurrence, risk factors, salpingectomy, salpingostomy, tubal pregnancy, ultrasonography, doppler ultrasonography, and prenatal. Articles included were randomized controlled trials, meta-analyses, systematic reviews, observational studies, and case reports. Additional publications were identified from the bibliographies of these articles. Only English-language articles were reviewed.

Validation methods: The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and weak recommendations).

Intended audience: Obstetrician-gynaecologists, family physicians, emergency physicians, midwives, registered nurses, nurse practitioners, medical students, and residents and fellows.

Summary statements (grade ratings in parentheses): RECOMMENDATIONS (GRADE RATINGS IN PARENTHESES).

Keywords: algorithm; pregnancy, ectopic; pregnancy, interstitial; pregnancy, tubal.

Publication types

  • Practice Guideline

MeSH terms

  • Cesarean Section
  • Female
  • Humans
  • Pregnancy
  • Pregnancy, Ectopic / diagnosis*
  • Pregnancy, Ectopic / therapy*
  • Pregnancy, Tubal / diagnosis
  • Pregnancy, Tubal / surgery
  • Salpingectomy
  • Ultrasonography