[Role of conservative therapy and medical treatment in ectopic pregnancy: literature review and clinical trial comparing medical treatment and conservative laparoscopic treatment].
OBJECTIVE
to compare methotrexate (MTX) to laparoscopic salpingotomy for conservative management of ectopic pregnancy (EP).


METHODS
prospective randomized study.


METHODS
eighty-nine patients were randomized into 2 groups using a random number table. Inclusion criteria were an EP visualized by ultrasound with a pretherapeutic score < or = 13 as assessed by 6 criteria graded from 1 to 3: gestational age, hCG level, P level, abdominal pain, volume of the hemoperitoneum, and diameter of the hematosalpinx.


METHODS
1 mg/kg of MTX injected transvaginally into the ectopic pregnancy without anaesthesia or IM administration (1.5 mg/kg) when EP cannot be safely or easily punctured (group 1) versus laparoscopic salpingotomy (group 2).


RESULTS
the success rates defined by hCG levels returned to normal (< 10 mlU/mL) were 43 out of 46 in group 1 and 40 out of 43 in group 2. Medical treatment was significantly associated with shorter post-operative stay (24 vs 46 hours). hCG return to normal was quicker after laparoscopic treatment (13 vs 29 days). Reproductive performances were similar in both groups.


CONCLUSIONS
in selected cases of EP with a pretherapeutic score < or = 13, MTX treatment appeared to be as safe and efficient as was conservative treatment by laparoscopy, an expectant management should be offered as a treatment option only in women fulfilling the criteria for a good prognostic.
Fernandez
H
H
Hôpital Antoine Béclère, Service de Gynécologie-Obstétrique, Clamart.
Pauthier
S
S
Sitbon
D
D
Vincent
Y
Y
Doumerc
S
S
D000293:Adolescent; D000328:Adult; D005260:Female; D005493:Folic Acid Antagonists / Q000627:therapeutic use*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008727:Methotrexate / Q000627:therapeutic use*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011271:Pregnancy, Ectopic / Q000175:diagnosis / Q000628:therapy*; D011446:Prospective Studies; D012489:Salpingostomy / Q000379:methods*; D016896:Treatment Outcome
D005493:Folic Acid Antagonists; D008727:Methotrexate
Place respective de l'abstention thérapeutique et du traitement médical dans les grossesses extra-utérines: revue de la littérature et essai thérapeutique comparant traitement médical et traitement conservateur par coelioscopie.