[Management of non-surgical treatment of ectopic pregnancy]

Abstract

Objective: To define non-surgical management of ectopic pregnancy using expectant management or medical treatment.

Methods: We reviewed French and English reports on Pubmed using to the following key words: "ectopic pregnancy, medical treatment, methotrexate, expectant management".

Results: Expectant management is possible for patients if they are selected according to precise criteria. It avoids therapeutic escalation, if there is a doubt as to whether it is a miscarriage or an ectopic pregnancy or for asymptomatic patients with spontaneous decreased hCG levels. Methotrexate is the medical treatment of choice. Side effects appear more rarely after one injection than multiple injections. Therefore, after multiple injections, it seems to be good to associate folinic acid. Local administration under sonographic control and mifepritone seem to be more efficient than intramuscular injection in case of active ectopic pregnancy (progesterone level and hCG level high). Two treatment protocols, the single dose and the multidose, have been reported and results are comparable when the success rate is defined as a negative hCG level associated with non-surgical intervention. This management can be handled on an outpatient basis but the patient's acceptance must be complete. Decreased hCG level is controlled in comparison with a standard curve. An additional dose of methotrexate is necessary when hCG levels are above the value of the curve on day 2, day 4, day 7 or day 10. Surgical management is necessary in case of tubal rupture. The occurrence of pain following methotrexate therapy should not be the sole indication for surgical intervention.