Conservative management of tubal ectopic pregnancy.
In this chapter an overview is given of the best available evidence on the conservative treatment for tubal ectopic pregnancy, i.e., expectant management and medical treatment with systemic methotrexate. From the two randomized controlled trials on expectant management, no conclusions can be drawn yet. It may be that women with low serum hCG levels need not be treated at all, but more research needs to be done in this subgroup of women to reach firm conclusions. Systemic methotrexate in a fixed multiple-dose i/m regimen can be recommended for hemodynamically stable women with an unruptured tubal ectopic pregnancy and no signs of active bleeding presenting with serum hCG concentrations<3,000 IU/l. In women with serum hCG concentrations<1,500 IU/l, a single-dose methotrexate regimen can be considered.
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Department of Obstetrics and Gynaecology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands. n.m.vanmello@amc.nl
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Hajenius
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D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage* / Q000009:adverse effects; D006063:Chorionic Gonadotropin / Q000097:blood*; D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000523:psychology / Q000628:therapy*; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods / Q000523:psychology; D008727:Methotrexate / Q000008:administration & dosage* / Q000009:adverse effects; D011247:Pregnancy; D011274:Pregnancy, Tubal / Q000097:blood / Q000523:psychology / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D016216:Ultrasonography, Prenatal
D000020:Abortifacient Agents, Nonsteroidal; D006063:Chorionic Gonadotropin; D008727:Methotrexate