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.