gynecology and obstetrics
Ectopic Pregnancy
Treatment of Ectopic Pregnancy
Usually,methotrexatefor small, unruptured ectopic pregnancies Surgical resection if rupture is suspected or criteria are not met formethotrexatetreatment Rho(D) immune globulin if the woman is Rh-negative The American College of Obstetricians and Gynecologistsadvises that patients with a tubal pregnancy may be treated withmethotrexateif none of the followingabsolute contraindicationsis present: Intrauterine pregnancy Ruptured ectopic pregnancy Hemodynamically unstable Sensitivity tomethotrexate Evidence of Overview of Immunodeficiency Disorders None Moderate to severe Evaluation of Anemia , Active pulmonary disease or Peptic Ulcer Disease None Clinically important hepatic or renal dysfunction Breastfeeding Unable to participate in follow-up surveillance Additionally, the followingrelative contraindicationsshould be considered: Embryonic cardiac activity detected by transvaginal ultrasonography High initial hCG concentration Ectopic pregnancy > 4 cm in size (as imaged on transvaginal ultrasonography) Refusal to accept blood donation In a commonly used protocol, beta-hCG is measured on day 1, and the patient is given a single dose ofmethotrexate50 mg/m2 IM. Beta-hCG measurement is repeated on days 4 and 7. If the beta-hCG level does not decrease by 15% from day 4 to 7, a 2nd dose ofmethotrexateor surgery is needed. Alternatively, other protocols can be used. are approximately 90%; 9% of women have complications that require hospitalization ( Treatment reference ). Usually,methotrexatecan be used, but surgery is indicated when rupture is suspected, the patient is not able to comply with follow-up surveillance aftermethotrexatetherapy, ormethotrexateis ineffective. Hemodynamically unstable patients require immediate laparotomy and treatment of Treatment of hemorrhagic shock . For stable patients, surgical treatment is usually laparoscopic surgery; sometimes laparotomy is required. If possible, salpingotomy is done to conserve the tube, and the ectopic pregnancy is removed. Salpingectomy is indicated in any of the following cases: The ectopic pregnancy has ruptured. Hemorrhage continues after salpingotomy. The tube has been reconstructed. The ectopic pregnancy represents a failure of a previous sterilization procedure, particularly if the pregnancy is in the blind-ending distal segment in women who have had a previous partial salpingectomy. Only the irreversibly damaged portion of the tube is removed, maximizing the chance that tubal repair can restore fertility. The tube may or may not be repaired. After a cornual pregnancy, the tube and ovary involved can usually be salvaged, but occasionally repair is impossible, making hysterectomy necessary. or surgery, are given Prevention . 1.Barnhart KT, Gosman G, Ashby R, Sammel M: The medical management of ectopic pregnancy: a meta-analysis comparing "single dose" and "multidose" regimens.Obstet Gynecol101(4):778-784, 2003. doi:10.1016/s0029-7844(02)03158-7 