[Non surgical management of ectopic pregnancy]

ABSTRACT

During the past 25 years, the incidence of ectopic pregnancy has progressively increased while the morbidity and mortality have substantialy decreased, and the treatment has progressed from salpingectomy by laparotomy to conservative surgery by laparoscopy and more recently to medical therapy with Methotrexate or expectant management. This therapeutic transition from surgical emergency to non surgical management has been attributed to early diagnosis through the use of sensitive assays for hcg and the high definition of vaginal ultrasound. By using these sensitive diagnostic tools, we are now able to select those patients who are most likely to respond to exectant or medical management versus those who are at high risk of rupture and require surgery. We have reviewed the scientific literature on ectopic pregnancy published over the past 20 years, with the aim to assess the value of non surgical management of etopic pregnancy. Predictor factors of expectant management are discussed. Medical therapy with methotrexate results, indications, Unplesant side effects and complications are detailed. Several protocols are defined and therapeutic supervision is established. The authors offred several recommendations for OB/GY which will optimize the effectivness of non invasive methods for treatment of ectopic pregnancy