title: A Clinical Experience of Ectopic Pregnancies with Initial Free Intraperitoneal Fluid.
abstract: BACKGROUND
  Extra-uterine pregnancy or Ectopic Pregnancy (EP) is a major health problem for pregnant women, presenting as a potentially life-threatening emergency in the first trimester. There are three major options for the treatment of EP: expectant management, surgical treatment and medical management. The presence of free intraperitoneal fluid in EP-diagnosed patients is crucial for treatment planning and evaluation.
  
  
  OBJECTIVE
  To compare the outcomes of both the expectant man-agement and medical treatment with methotrexate (MTX) in ectopic pregnancies with free intraperitoneal fluid.
  
  
  METHODS
  This retrospective cohort study inclu-ded a total of 91 ectopic pregnancies with or without rupture in which the women had initial free intraperitoneal fluid and were haemodynamically stable. Serial β-HCG measurements were used to assess the outcome of expectant management and medical treatment with MTX. For the statistical analysis, the SPSS statistical software package, version 22.0 (Chicago, IL, USA), was used. For the quantitative variables that were not distributed normally, the Kruskal-Wallis test and the Mann-Whitney U test were performed for the evaluation of differences between the groups.
  
  
  RESULTS
  It was observed that the success rate with expectant management was 81% (initial β HCG concentration 626±443 mIU/mL). With a single dose of MTX, it was 76% (initial β HCG concentration 2124±1647 mIU/mL) and with a total single or double dose of MTX, it was 88% (initial β HCG concentration 2252±78 mIU/mL) from among EP with or without rupture in women with initial free intraperitoneal fluid during diagnosis. There was no significant difference between the groups with regard to ultrasonography findings.
  
  
  CONCLUSIONS
  Expectant management or medical treatment with methotrexate should be the first line treatment for ectopic pregnancies with initial free intraperitoneal fluid, albeit with rupture, in patients who are haemodynamically stable, along with β-HCG follow-up.
authors.affiliation: Lecturer, Department of Obstetrics and Gynecology, Fatih Sultan Mehmet Training and Research Hospital , İstanbul, Turkey .
authors.forename: Mehmet Akif
authors.initials: MA
authors.lastname: Sargin
authors.affiliation: Lecturer, Department of Obstetrics and Gynecology, Fatih Sultan Mehmet Training and Research Hospital , İstanbul, Turkey .
authors.forename: Murat
authors.initials: M
authors.lastname: Yassa
authors.affiliation: Lecturer, Department of Obstetrics and Gynecology, Fatih Sultan Mehmet Training and Research Hospital , İstanbul, Turkey .
authors.forename: Bilge Dogan
authors.initials: BD
authors.lastname: Taymur
authors.affiliation: Lecturer, Department of Obstetrics and Gynecology, Fatih Sultan Mehmet Training and Research Hospital , İstanbul, Turkey .
authors.forename: Ayhan
authors.initials: A
authors.lastname: Çelik
authors.affiliation: Lecturer, Department of Obstetrics and Gynecology, Umraniye Training and Research Hospital , İstanbul, Turkey .
authors.forename: Sibel
authors.initials: S
authors.lastname: Aydin
authors.affiliation: Student, Department of Obstetrics and Gynecology, Fatih Sultan Mehmet Training and Research Hospital , İstanbul, Turkey .
authors.forename: Emrah
authors.initials: E
authors.lastname: Orhan
authors.affiliation: Associate Professor, Department of Obstetrics and Gynecology, Fatih Sultan Mehmet Training and Research Hospital , İstanbul, Turkey .
authors.forename: Niyazi
authors.initials: N
authors.lastname: Tug
keywords: Chorionic Gonadotropin; Haemoperitoneum; Methotrexate