[Pathophysiologic principles and clinical effects of local drug therapy of tubal pregnancies].
OBJECTIVE
An empirically established serum beta human chorionic gonadotropin (beta-HCG) threshold level of 2,500 IU/l is considered as the limit for successful drug therapy. The purpose of our study was to ascertain if this threshold level correlates with the histopathology. Further, we evaluated the effects of local drug therapy on the tubal wall.


METHODS
Between 1988 and 1993 129 cases of tubal pregnancies were treated by local prostaglandin F2 alpha instillation. For final cure 30 patients had to undergo further surgical measures. Our study was based upon the histological samples which were excised during secondary operation.


RESULTS
Below 2,500 IU/l beta-HCG, intraluminal growth of the trophoblast is more frequent, whereas at higher values extraluminal spread predominates (p = 0.0045). Cells of ectopic trophoblast proliferate significantly slower than those of intrauterine pregnancies. Prostaglandin F2 alpha application selectively destroys ectopic gestational tissue and preserves the tubal wall.


CONCLUSIONS
The integrity of the tubal wall with its contractile potential is essential for successful therapy by local instillation of prostaglandin F2 alpha.
Klein
M
M
Geburtshilflich-Gynäkologische Abteilung, Hanusch-Krankenhaus, Wien.
Husslein
P
P
D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage*; D000287:Administration, Topical; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood*; D015237:Dinoprost / Q000008:administration & dosage*; D005187:Fallopian Tubes / Q000187:drug effects / Q000473:pathology; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D015552:Injections, Intralesional; D011247:Pregnancy; D011274:Pregnancy, Tubal / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology; D012189:Retrospective Studies; D014327:Trophoblasts / Q000187:drug effects / Q000473:pathology
D000020:Abortifacient Agents, Nonsteroidal; D018997:Chorionic Gonadotropin, beta Subunit, Human; D015237:Dinoprost