A prospective series of unruptured ectopic pregnancies treated by tubal injection with hyperosmolar glucose.
OBJECTIVE
To evaluate the safety and efficacy of hyperosmolar glucose injection in select unruptured tubal gestations with hCG levels less than 2500 mIU/mL.


METHODS
In this prospective series, 16 patients with an hCG titer less than 2500 mIU/mL and an unruptured ectopic pregnancy were treated by tubal injection with hyperosmolar (50%) glucose. Hyperosmolar glucose was injected transabdominally into the antimesenteric site of the tubal pregnancy, using a 20-gauge spinal needle. The main outcome measures evaluated were duration of surgery, success rate, time to resolution, and follow-up tubal patency rates.


RESULTS
Ninety-four percent (15) of the subjects were treated successfully with a median time to resolution of 24 days (range 5-78). The one treatment failure required methotrexate because of rising hCG titers and worsening pain 4 days after the patient was treated with hyperosmolar glucose. The mean (+/- standard error) duration of surgery was 45 +/- 6 minutes. So far, all ten patients undergoing postoperative hysterosalpingograms have demonstrated tubal patency in the treated tube.


CONCLUSIONS
Laparoscopic injection with hyperosmolar glucose is an effective, systemically nontoxic alternative treatment for select unruptured ectopic pregnancies (hCG less than 2500 mIU/mL) that achieves tubal patency rates comparable to other conservative medical and surgical treatments.
Yeko
T R
TR
Department of Obstetrics and Gynecology, University of South Florida College of Medicine, Tampa.
Mayer
J C
JC
Parsons
A K
AK
Maroulis
G B
GB
D006063:Chorionic Gonadotropin / Q000097:blood; D005186:Fallopian Tube Patency Tests; D005260:Female; D005947:Glucose / Q000008:administration & dosage*; D006801:Humans; D007267:Injections; D010535:Laparoscopy; D008727:Methotrexate / Q000627:therapeutic use; D009994:Osmolar Concentration; D011247:Pregnancy; D011274:Pregnancy, Tubal / Q000097:blood / Q000628:therapy*; D011446:Prospective Studies
D006063:Chorionic Gonadotropin; D005947:Glucose; D008727:Methotrexate