[Non surgical management of ectopic pregnancy].
During the past 25 years, the incidence of ectopic pregnancy has progressively increased while the morbidity and mortality have substantialy decreased, and the treatment has progressed from salpingectomy by laparotomy to conservative surgery by laparoscopy and more recently to medical therapy with Methotrexate or expectant management. This therapeutic transition from surgical emergency to non surgical managment has been attributed to early diagnosis through the use of sensitive assays for hCG and the high definition of vaginal ultrasound. By using these sensitive diagnostic tools, we are now able to select those patients who are most likely to respond to expectant or medical managment versus those who are at high risk of rupture and require surgery. We have reviewed the scientific literature on ectopic pregnancy published over the past 20 years, with the aim to assess the value of non surgical managment of etopic pregnancy. Predictor factors of expectant managment are discussed. Medical therapy with methotrexate: results, indications, Unpleasant side effects and complications are detailed. Several protocols are defined and therapeutic supervision is etablished. The authors offred several recommandations for OB/GY wich will optimize the effectivness of non invasive methods for treatment of ectopic pregnancy.
Kdous
Moez
M
Service de gynécologie obstétrique-Centre hospitalier intercommunmal de Créteil, France.
D000328:Adult; D000818:Animals; D006063:Chorionic Gonadotropin / Q000097:blood; D002985:Clinical Protocols; D004791:Enzyme Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D005493:Folic Acid Antagonists / Q000627:therapeutic use; D006801:Humans; D002955:Leucovorin / Q000008:administration & dosage / Q000627:therapeutic use; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D018579:Patient Selection; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000628:therapy*; D011379:Prognosis; D011817:Rabbits; D051381:Rats; D012307:Risk Factors; D013997:Time Factors; D014463:Ultrasonography
D006063:Chorionic Gonadotropin; D004791:Enzyme Inhibitors; D005493:Folic Acid Antagonists; D002955:Leucovorin; D008727:Methotrexate