[Can medical treatment be the first-line treatment for most ectopic pregnancies? A series of 202 patients].
OBJECTIVE
To assess the efficacy and safety of a liberal policy of medical treatment for ectopic pregnancies (EUP).


METHODS
Retrospective study of EUP that received active management between January 1999 and December 2003. Patients with rupture or near-rupture and those who refused medical treatment received surgical treatment. Other patients were treated by methotrexate.


RESULTS
Two hundred and two EUP were managed; 26 % were treated surgically, 74 % medically. The success rate of medical treatment was 83 %. A ss-hCG threshold of 2526 IU/l was selected. Under this level, the success rate was 90.7 % compared with 68 % when it was higher (p=0.001). Cardiac activity tripled the failure rate. Morbidity with medical treatment consisted of an augmentation in transaminases in 18.8 % and one case of severe dermatosis (0.7 %). Almost half of the patients treated medically required hospitalizations.


CONCLUSIONS
The extension of medical treatment in our population to 74 % of all EUP yielded a high success rate, 83 %.
Garbin
O
O
Service de gynécologie-obstétrique, pôle de gynécologie-obstétrique, hôpitaux universitaires de Strasbourg, SIHCUS-CMCO, 19, rue Louis-Pasteur, 67300 Schiltigheim, France. olivier.garbin@sihcus.fr
Helmlinger
C
C
Meyer
N
N
David-Montefiore
E
E
Vayssiere
C
C
D000020:Abortifacient Agents, Nonsteroidal / Q000627:therapeutic use; D000328:Adult; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood; D005260:Female; D005602:France; D006801:Humans; D008727:Methotrexate / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000175:diagnosis; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D012189:Retrospective Studies; D012871:Skin Diseases / Q000473:pathology; D000637:Transaminases / Q000097:blood; D016896:Treatment Outcome
D000020:Abortifacient Agents, Nonsteroidal; D018997:Chorionic Gonadotropin, beta Subunit, Human; D000637:Transaminases; D008727:Methotrexate