This review addresses recent publications that investigate etiology, epidemiology and different modalities in diagnosis and therapy for ectopic pregnancy. A significant proportion of recent work has focused in the development of new diagnostic tools to aid in the early detection of ectopic pregnancy. Diagnostic modalities have included systemic and local markers, vascular endothelial growth factor, vascular cell adhesion molecule-1, urokinase plasminogen activator receptor, cervical fetal fibronectin, and hormonal level determinations. In addition, magnetic resonance imaging, ultrasonography, color flow mapping and endometrial thickness have been evaluated. New studies have investigated controversial issues related to the cost of the medical versus surgical treatment and the use of different medications and techniques for the management of ectopic pregnancy. Most important of all, several lines of investigation have addressed the use of human chorionic gonadotropin, algorithms, and scoring systems as prognostic indicators of successful therapy and to determine the risk of complications. The management of cervical, interstitial and heterotopic pregnancy is evaluated in this review and a summary of recent proposed diagnostic tools and concepts in management is also presented.

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Placement of Laminaria japonica 24 hours before PGE2 vaginal suppository-induced abortion resulted in a significantly shorter induction-to-delivery time, and pretreatment with Laminaria japonica decreased the number of suppositories required to complete abortion. Pretreatment with intracervical PGE2 gel increased pain associated with Laminaria placement and did not improve the efficacy of the procedure.

Objective: To compare the abortifacient efficacy of vaginal prostaglandin (PG) E 2 suppositories with and without pretreatment with intracervical PGE 2 gel and Laminaria japonica.Methods: One hundred seventy-five women between 16 and 20 weeks' gestation requesting abortion were divided randomly into three groups. Forty-one received PGE 2 vaginal suppositories alone to induce abortion, 72 had Laminaria placed 24 hours before vaginal PGE 2 , and 62 were given intracervical 0.5 mg PGE 2 gel plus Laminaria 24 hours before vaginal PGE 2 . Maternal demographic characteristics, induction to delivery time, number of suppositories required, and complications were analyzed.Results: The mean maternal age, gravidity, parity, race, and gestational age were similar among groups. Ninety-five percent of all women delivered within 24 hours. The induction to delivery time was significantly longer in the PGE 2only women (mean ؎ standard deviation 689 ؎ ؎ ؎ 319 minutes) compared with that of those receiving PGE 2 plus Laminaria (487 ؎ ؎ ؎ 321 minutes) and PGE 2 plus Laminaria plus gel (547 ؎ ؎ ؎ 374 minutes, P ‫؍‬ ‫؍‬ ‫؍‬ .01). There was a statistically significant difference in the number of suppositories needed to complete the abortion process. The PGE 2 -only group required more suppositories (median three, range 1-8) compared with PGE 2 plus Laminaria (median 3, range 1-3) and PGE 2 plus Laminaria plus gel (median 2.5, range 1-9; P ‫؍‬ .001). Patients in the PGE 2 plus Laminaria plus gel group reported more pain associated with placement (median pain score 4, range 0 -10) compared with PGE 2 plus Laminaria (median 2, range 0 -9; P ‫؍‬ .003). There was a lower incidence of febrile episodes in the PGE 2 -only group (29%) compared with PGE 2 plus Laminaria (68%) and PGE 2 plus Laminaria plus gel (54%, P ‫؍‬ ‫؍‬ ‫؍‬ .002).Conclusion: Placement of Laminaria japonica 24 hours before PGE 2 vaginal suppository-induced abortion resulted in a significantly shorter induction-to-delivery time, and pretreatment with Laminaria japonica decreased the number of suppositories required to complete abortion. Pretreatment with intracervical PGE 2 gel increased pain associated with Laminaria placement and did not improve the efficacy of the procedure. (Obstet Gynecol 1998;92:398 -402.