The use of a pretherapeutic, predictive score to determine inclusion criteria for the non-surgical treatment of ectopic pregnancy.
Non-surgical management of ectopic pregnancy has recently become an alternative to surgery. We have investigated a pretherapeutic score to define the indication for non-surgical and surgical treatment in 61 patients with ectopic pregnancy. The score was performed before the patients' inclusion in a nonsurgical management scheme. The score used six criteria which were evaluated on a scale from 1 to 3: gestational age, human chorionic gonadotrophin (HCG) level, progesterone level, abdominal pain, haemoperitoneum volume and haematosalpinx diameter (estimated by laparoscopy or transvaginal ultrasound). Three scores, 10, 11 and 12, were studied in order to define a threshold beyond which surgical treatment should be performed. For each one, sensitivity, specificity and positive and negative predictive values were analysed. The success rate of non-surgical treatment was 75% (46/61). For patients undergoing medical treatment with a score less than or equal to 12, the success rate was significantly higher compared with a success rate of 50% when the score was greater than 12. We conclude that a score less than or equal to 12 permits non-surgical management with a success rate of 82%. A score greater than 12 indicates that laparoscopic surgery may be more suitable. The choice between different non-surgical approaches, did not influence the success rate. When ultrasound reveals embryo heart activity, medical treatment is always possible if the score is less than or equal to 12.
Fernandez
H
H
Department of Obstetrics and Gynaecology, Hôpital Antoine Béclère, Clamart, France.
Lelaidier
C
C
Thouvenez
V
V
Frydman
R
R
D005260:Female; D006801:Humans; D011237:Predictive Value of Tests; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013997:Time Factors