Future Perspectives of Ectopic Pregnancy Treatment—Review of Possible Pharmacological Methods

Abstract

Ectopic pregnancy, that is, a blastocyst occurring outside the endometrial cavity of the uterus, affects nearly 2% of pregnancies. The treatment of ectopic pregnancy is surgical or pharmacological. Since surgical management is associated with numerous serious side effects, conservative treatment is sought. The treatment of choice in the majority of cases is based on pharmacotherapy with methotrexate (MTX) in a single- or multi-dose regimen. Although the efficacy of methotrexate reaches between 70 and 90%, its use requires specific conditions regarding both the general condition of the patient and the characteristic features of the ectopic pregnancy. Moreover, MTX can cause severe adverse effects, including stomatitis, hepatotoxicity and myelosuppression. Therefore, clinicians and researchers are still looking for a less toxic, more effective treatment, which could prevent surgeries as a second-choice treatment. Some studies indicate that other substances might constitute a good alternative to methotrexate in the management of ectopic pregnancies. These substances include aromatase inhibitors, especially letrozole. Another promising substance in EP treatment is gefitinib, an inhibitor of EGFR tyrosine domain which, combined with MTX, seems to constitute a more effective alternative in the management of tubal ectopic pregnancies. Other substances for local administration include KCl and absolute ethanol. KCl injections used in combination with MTX may be used when foetal heart function is detected in cervical ectopic pregnancies, as well as in heterotopic pregnancy treatment. Absolute ethanol injections proved successful and safe in caesarean scar pregnancies management. Thus far, little is known about the use of those substances in the treatment of ectopic pregnancies, but already conducted studies seem to be promising.

Increasing Trends of Laparoscopic Procedures in Non-obstetric Surgery during Pregnancy Over 17 Years at a Single Center

“…In cases where GY surgery is indicated, heterotopic pregnancy refers to the simultaneous presence of intrauterine pregnancy (IUP) and heterotopic pregnancy. While the occurrence of heterotopic pregnancy in spontaneous pregnancies was less than 1 in 30,000, the prevalence increases to 0.09-1% with the use of ART [14,15)]. Early diagnosis of heterotopic pregnancy is crucial due to the risk of rupture at the heterotopic site [16,17].…”

Successful Ultrasound-Guided Methotrexate Intervention in the Treatment of Heterotopic Interstitial Pregnancy: A Case Report and Literature Review

“…Since the first report of the successful treatment of HIP by the ultrasound-guided injection of KCl in 1992 [ 7 ], many medical centers have carried out studies, all of which have achieved good results. However, KCL mainly acts on embryo or fetal heart activity, which leads to fetal death, and does not inhibit trophoblast proliferation [ 48 ]. As a result, self-limited vaginal bleeding has occasionally been reported during the duration of an IUP [ 49 ].…”

Laparoscopy versus Laparotomy in the Surgical Management of Ectopic Pregnancy: Integrative Literature Review

“…Maternal morbidity and mortality in the first trimester in the first trimester, there is morbidity and death. The life of a woman is at danger if treatment and diagnosis are delayed [25,26]. Acute ruptured EP can result in significant hemorrhage and decrease of blood volume, affecting the liver, kidneys, and other crucial organs' blood flow and raising the possibility of harm to visceral function.…”

“…The laparotomy was the main surgical procedure used for more than 200 years. Bruhart et al published the first study on laparoscopic surgery for an ectopic pregnancy in 1980 [26,35,36].While open laparotomies were once the standard surgical procedure for treating EPs, laparoscopy is now becoming increasingly common for EP diagnosis and management [29,30]. Laparoscopy is well accepted to play a significant part in the surgical EP treatment and that it has expanded the scope of available diagnostic and therapeutic options [37].…”