title: Nonsurgical management of unruptured isthmic ectopic pregnancy: preliminary experience.
abstract: Five unruptured isthmic tubal pregnancies diagnosed at laparoscopy were treated with either methotrexate/citrovorum factor rescue (MTX/CF) (n = 4) or observation alone (n = 1). Entry criteria required that the ectopic be fully visualized, no greater than 3 cm in diameter, with intact serosa, and without active bleeding. Treatment selection was based upon preoperative levels of beta-hCG with MTX/CF given to subjects exhibiting a plateaued or rising pattern and observation alone given those with falling levels. Subjects were followed with serial measurements of beta-hCG, complete blood counts, and liver function tests. In all subjects the ectopic pregnancy resolved without further surgery. Time to resolution (first day of treatment to undetectable beta-hCG) ranged from 12 to 55 days. Of the five subjects studied, follow-up hysterosalpingograms in four demonstrated tubal patency on the side of the ectopic gestation.
mesh_terms: D000328:Adult; D000818:Animals; D006063:Chorionic Gonadotropin / Q000032:analysis; D002985:Clinical Protocols / Q000592:standards; D004359:Drug Therapy, Combination; D005187:Fallopian Tubes / Q000601:surgery; D005260:Female; D006801:Humans; D002955:Leucovorin / Q000494:pharmacology / Q000627:therapeutic use; D008727:Methotrexate / Q000494:pharmacology / Q000627:therapeutic use; D010057:Oviducts / Q000187:drug effects; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000188:drug therapy* / Q000601:surgery
chemical_list: D006063:Chorionic Gonadotropin; D002955:Leucovorin; D008727:Methotrexate