Current status of management of ectopic pregnancy

Abstract

Objective To evaluate the relative safety and efficacy of conservative surgical, medical and expectant management. Design Relevant studies were identified through a computer Medline search. Results Laparoscopy is not mandatory for diagnosis of ectopic pregnancy, which can be diagnosed by the use of transvaginal scan and estimation of quantitative βhCG. Laparoscopic salpingectomy or salpingostomy is preferred to laparotomy in a haemodynamically stable patient and should be used more frequently. The role of expectant management in ectopic pregnancy is very limited. Spontaneous resolution may occur only in a selected group of unruptured ectopic pregnancies with an initial βhCG of <200 mIU/ml and declining hCG level. Systemic methotrexate administration is a promising treatment in patients with early and unruptured ectopic pregnancy. Several prospective studies have shown success rates of 85–94% following single‐dose systemic methotrexate treatment. Single‐dose methotrexate is associated with fewer side‐effects but is as effective as multiple‐dose regimes. Recurrent ectopic pregnancy and intrauterine pregnancy rates following systemic methotrexate are comparable to those following laparoscopic salpingostomy. Conclusion Systemic methotrexate is a viable alternative to laparoscopic salpingostomy for women wishing to preserve their fertility. A large prospective randomized trial is needed to establish whether laparoscopic surgery or methotrexate should be the first‐line treatment.

Experience with laparoscopic surgery at the Aga Khan Hospital, Nairobi

“…In the United Kingdom the increase of ectopic pregnancies doubled from 4.9 to 9.6 per 1000 pregnancies between 1973 and 1993, whilst the mortality decreased from 16 to 3 per 10,000 cases(11). Sau et al (12) recommended that laparoscopic surgery be the preferred option to laparotomy in the management of haemodynamically stable patients with ectopic pregnancies (12). At the Aga Khan Hospital, Nairobi, 33 cases of ectopic pregnancies (8.08% were managed laparoscopically between May 2000 and May 2002.…”

Laparoscopic treatment of unruptured 13-week tubal pregnancy

“…The management of ectopic pregnancy has undergone a revolution in the past few decades [1,2,6]. Laparoscopy still remains the gold standard for diagnosis and treatment of extrauterine pregnancy and is as safe and effective as laparotomy [2,3].…”

“…Laparoscopy still remains the gold standard for diagnosis and treatment of extrauterine pregnancy and is as safe and effective as laparotomy [2,3].…”

“…A laparotomy is usually performed in such cases, regardless of whether it is a ruptured or unruptured one [1,2]. Since the 1980s, laparoscopic management of ectopic pregnancy has been widely accepted for hemodynamically stabile patients [1,2,3,4].…”

“…A laparotomy is usually performed in such cases, regardless of whether it is a ruptured or unruptured one [1,2]. Since the 1980s, laparoscopic management of ectopic pregnancy has been widely accepted for hemodynamically stabile patients [1,2,3,4]. However, only one report about laparoscopic surgery for advanced ectopic pregnancy has been published previously in the English literature [5].…”