Laparoscopic surgery or intramuscular methotrexate administration are safe and effective treatments in clinically stable women in whom a nonruptured ectopic pregnancy has been diagnosed, according to new clinical management guidelines from the American College of Obstetricians and Gynecologists (ACOG). The guidelines offer a review of the information on the current understanding of tubal ectopic pregnancy and provide guidance for timely diagnosis and management. Among ACOG’s recommendations:

• In clinically stable women in whom a nonruptured ectopic pregnancy has been diagnosed, laparoscopic surgery or intramuscular methotrexate administration are safe and effective treatment. (Level A)
• The decision for surgical management or medical management of ectopic pregnancy should be guided by the initial clinical, laboratory, and radiologic data as well as patient-informed choice based on a discussion of the benefits and risk of each approach. (Level A)
• Surgical management of ectopic pregnancy is required when a patient is exhibiting any of the following: hemodynamic instability, symptoms of an ongoing ruptured ectopic mass, or signs of intraperitoneal bleeding. (Level A)
• Serum hCG values alone should not be used to diagnose an ectopic pregnancy and should be correlated with the patient’s history, symptoms, and ultrasound findings. (Level B)