Clinical diagnosis and treatment of ectopic pregnancy.
BACKGROUND
Implantation of the zygote outside the uterine cavity occurs in 2% of all pregnancies. The product of conception can be removed safely by laparoscopic surgery and be submitted for histological examination. The rate of ectopic pregnancies has increased from 0.5% in 1970 to 2% today. The prevalence of ectopic pregnancy in all women presenting to an emergency department with first-trimester bleeding, lower abdominal pain, or a combination of the 2 is between 6% and 16%. DESIGNATION: Workup of all localizations of ectopic pregnancies at a university department of obstetrics and gynecology.


METHODS
Comparison of diagnostic and therapeutic modalities from the surgical laparoscopic approach to nonsurgical, medical options.


RESULTS



METHODS
Tubal pregnancies: (1) to preserve tubal function, salpingotomy, partial salpingectomy followed by laparoscopic anastomosis, or fimbrial milking is performed. (2) Tubectomy or salpingectomy is performed only in severely damaged or ruptured tubes or if the patient does not desire further pregnancies. Nontubal ectopic pregnancies (ovarian pregnancy, ectopic abdominal pregnancy, interstitial or cornual pregnancy/rudimentary horn, intraligamental and cervical pregnancies) all require their own specific treatment.


METHODS
The predominant drug is methotrexate, but other systemic drugs, such as actinomycin D, prostaglandins, and RU 486, can also be applied.


RESULTS
Tubal rupture is a complication of late diagnosed tubal pregnancy that is more difficult to treat conservatively and often indicates tubectomy or segmental resection. In 5% to 15% of treated ectopic pregnancy cases, remnant conception product parts may require a final methotrexate injection.


CONCLUSIONS
This article is a review to aid clinical diagnosis of ectopic pregnancies that now can be diagnosed earlier and treated effectively by laparoscopic surgery.
Doctor, Kiel School of Gynaecological Endoscopy, Department of Gynaecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, Kiel, Germany. kiel.school@uksh.de
Ibrahim
I
Alkatout
Ulrich
U
Honemeyer
Alexander
A
Strauss
Andrea
A
Tinelli
Antonio
A
Malvasi
Walter
W
Jonat
Liselotte
L
Mettler
Thoralf
T
Schollmeyer
D000020:Abortifacient Agents, Nonsteroidal / Q000627:therapeutic use; D000714:Anastomosis, Surgical; D015415:Biomarkers / Q000097:blood; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood; D003937:Diagnosis, Differential; D005187:Fallopian Tubes / Q000601:surgery; D005260:Female; D014943:Global Health; D006801:Humans; D010535:Laparoscopy; D008727:Methotrexate / Q000627:therapeutic use; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D012307:Risk Factors; D058994:Salpingectomy; D018608:Ultrasonography, Doppler; D016216:Ultrasonography, Prenatal
D000020:Abortifacient Agents, Nonsteroidal; D015415:Biomarkers; D018997:Chorionic Gonadotropin, beta Subunit, Human; D008727:Methotrexate