Conservative approach in the management of ectopic pregnancy

Abstract

Introduction. Ectopic pregnancy is defined as the implantation of a fertilized ovum outside the uterine cavity and it is one of the leading causes of maternal morbidity and mortality. Localization and risk factors. The most common localization of ectopic pregnancy is within the fallopian tube, while other localizations include abdominal organs, ovaries, scars after previous cesarean sections, and cervix. Risk factors for ectopic pregnancy include previous fallopian tube injuries, infertility including multiple embryo transfers, use of contraceptives, smoking, older age, prior history of ectopic pregnancy, intentional abortions. Diagnostic procedures. Measurement of serum beta-human chorionic gonadotropin levels along with certain ultrasonography signs, i.e. extrauterine gestational sac, with a present yolk sac and/or embryo, with or without a cardiac activity, have the highest degree of reliability in making the diagnosis, whereas uncertain signs, such as ?blob? and ?bagel? signs, also have a high positive predictive value. Therapeutic modalities. Ectopic pregnancy can be treated by surgical, medical or expectant management. Expectant and medical management are reserved for hemodynamically stable patients who are adequately informed and where monitoring and control are possible. Conservative treatment. Before the initiation of treatment with methotrexate, it is necessary to rule out a vital intrauterine pregnancy, and consider the contraindications for methotrexate therapy, based on detailed medical history and laboratory tests. The Clinic of Obstetrics and Gynecology of the Clinical Center of Vojvodina uses a two-dose protocol by which methotrexate is administered intramuscularly and which has proven to be highly successful with few side effects. Surgical treatment modalities. Candidates for emergency laparoscopy or laparotomy are women who are hemodynamically unstable and who should not receive methotrexate. Conclusion. In properly selected patients, the success rate of methotrexate therapy is around 93%.