[Must we still operate on ectopic pregnancies?].
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 123 patients with ectopic pregnancy. The score was performed before the patients' inclusion in a non-surgical 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 82.1% (101/123). For patients undergoing medical treatment with a score < or = 12, the success rate was significantly higher compared with a success rate of 56% when the score was > 12. We conclude that a score < or = 12 permits non-surgical management with a success rate of 87%. A score > 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 < or = 12.
Hôpital Antoine-Béclère, Service de gynécologie-obstétrique, Clamart, France.
H
H
Fernandez
C
C
Lelaidier
P
P
Fournet
R
R
Frydman
D006063:Chorionic Gonadotropin / Q000097:blood; D003663:Decision Trees; D005260:Female; D005865:Gestational Age; D006801:Humans; D015907:Hysteroscopy; D010535:Laparoscopy; D008727:Methotrexate / Q000627:therapeutic use; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000097:blood / Q000145:classification / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D011374:Progesterone / Q000097:blood; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal
D006063:Chorionic Gonadotropin; D011374:Progesterone; D008727:Methotrexate
Faut-il encore opérer les GEU?