Local Treatment of Ectopic Pregnancy

Abstract

The treatment of ectopic pregnancies has evolved from a purely surgical route with routine removal of the fallopian tube to one with multiple options. Medical treatment can be administered systemically or via local injection. Local delivery of chemotherapeutic agents is a safe and proven modality that is especially indicated for pregnancies in which a laparoscopic approach is not ideal and systemic therapy either has failed or is not desired. Local therapy has the potential to document immediately the cessation of fetal heart activity. Nontubal ectopic pregnancies may be ideally suited to local therapy, especially when there is a fetal heart present. Transvaginal ultrasound is the preferred mode for guidance and laparoscopic guidance has a limited role. Although a multitude of agents have been proposed, methotrexate, KCl, and hyperosmolar glucose are the most widely used and readily available. Local therapy has an important place in the armamentarium of the treatment of ectopic pregnancies.

A cohort study to evaluate the effectiveness of laparoscopic-guided local injection of etoposide in the management of women with unruptured tubal pregnancy

“…Administration can be undertaken with either ultrasound or laparoscopic guidance. Even though there are a handful of reports showing the effectiveness of local injection of MTX on ectopic pregnancy, not only as first-line treatment but also as a rescue method (15,16), there is still uncertainty regarding the agent for local injection.…”

“…Furthermore, the best regimen for use with local injection is still uncertain (6), although MTX is the most widely used and readily available (7). In our previous reports (8-10), we found that etoposide, an antineoplastic agent that can produce cytotoxic effects by damaging DNA, thereby inhibiting or altering DNA synthesis, is a potential candidate drug for the management of ectopic pregnancy.…”

Primary abdominal pregnancy: A case report

“…[3,10] Lokal tedavi yeterli olmadığında sistemik metotreksat tedavisi veya cerrahi uygulanabilir. Biz olgumuzda ilk etapta sistemik metotreksat uygulamayı düşünsek de, hastada akut batın bulgularının gelişmesi nedeniyle cerrahi kararı verilmiştir.…”

An Early Abdominal Wall Ectopic Pregnancy Successfully Treated with Ultrasound Guided Intralesional Methotrexate: A Case Report

“…Many different agents have been used to treat ectopic pregnancies including systemic and local methotrexate, local potassium chloride and hyperosmolar glucose, prostaglandins, danazol, etoposide, and mifepristone [3]. Most investigators have reported varying success rates in the medical treatment of abdominal pregnancies with local potassium chloride and/or local methotrexate, sometimes with the addition of systemic methotrexate [4].…”