Int J Gynecol Obstet, 1992, 38: 107-I 13 International Federation of Gynecology and Obstetrics



of ectopic pregnancy

T. Tulandi Division of Reproductive

Endocrinology and Infertility.

Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec


(Received August 19th, 1991) (Revised and accepted November 14th, 1991)


Expectant treatment

Expectant management and medical treatment of ectopic pregnancy either systemically or locally are reviewed. Because of the risks of tubal rupture, this nonsurgical management should be done with utmost care. To date, surgical removal of an ectopic pregnancy remains the method of choice and this can be safely done by laparoscopy. Alternate treatments should be carefully evaluated in clinical trials.

Spontaneous tubal abortion or resorption is a well known phenomenon [ 11. Indeed, it has been long recognized that the occurrence of ectopic pregnancy is more frequent than its diagnosis. It is very likely that the recent capability of diagnosing early and unruptured ectopic pregnancy has eliminated cases which would have resolved spontaneously. In recent years several investigators have evaluated the feasibility and safety of expectant treatment of ectopic pregnancy [2-61 (Table 1). Carp et al. [3] utilized strict criteria to patients whom they treated expectantly. The diagnosis of tubal ectopic pregnancy was established by laparoscopic examination. In 11 patients whose serum &hCG levels were ~250 mIU/ml and declining and the tubal diameter was c 2 cm, the treatment was successful. Three patients subsequently had intrauterine pregnancies and one patient had a recurrent ectopic pregnancy. A similar observation was reported by Fernandez et al. [4]. They found that the probability of spontaneous resolution is high when the serum phCG at diagnosis is less than 1000 mIU/ml. Increasing serum &hCG levels indicate growth of trophoblasts and preclude the use of expectant treatment. However, rupture can still occur despite falling serum @-hCG levels [7]. Likewise, we

Keywords: Non-surgical; pregnancy.



Serial measurements of serum P-human chorionic gonadotropin (&hCG) and early transvaginal ultrasound examination have enabled detection of early and unruptured tubal ectopic pregnancy. This early diagnosis has allowed treatment without removing the tube. Recently, even more conservative approaches have been advocated, including expectant and medical treatments. The purpose of this review is to provide a summary of nonsurgical treatment of ectopic pregnancy and to evaluate their efficacy and safety. 0020-7292/92/%05.00 0 1992 International

Federation of Gynecology and Obstetrics Printed and Published in Ireland




Table 1. Expectant management of ectopic pregnancy. Authors

No. of cases

Serum P-hCG (mIU/ml)

Sauer et al. (1987) 1191 Adoni et al. (1986) [2]

5 11

Carp et al. (1986) [3] Garcia et al. (1987) [5] Femandez et al. (1988) [4] Makinen et al. (1990) [6]

14 13 14 33

65-1010 ? 14-250 f 160-1500 78-8000 s 2500

recently reported rupture of tubal pregnancy in 2 patients whose serum &hCG levels were low (less than 400 mIU/ml) and declining [8]. Reproductive performance of patients after expectant management is still unclear. Tubal patency in the majority of patients and intrauterine pregnancies have been reported. However, leaving the product of conception inside the tube might also lead to tubal occlusion [9-l 11. It appears that expectant management of ectopic pregnancy can be done in a selective group of patients whose serum &hCG levels are less than 1000 mIU/ml and falling and the diameter of the tube is

Nonsurgical treatment of ectopic pregnancy.

Expectant management and medical treatment of ectopic pregnancy either systemically or locally are reviewed. Because of the risks of tubal rupture, th...
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