Treatment of ectopic pregnancy by local injection of hypertonic glucose: a randomized trial comparing administration guided by transvaginal ultrasound or laparoscopy

Abstract

Objective: To study local treatment of ectopic pregnancy by injection of hyperosmolar (50%) glucose, guided either by transvaginal ultrasound or by laparoscopy.

Methods: Eighty women were randomized, 39 into the sonography and 41 into the laparoscopy group. Criteria for inclusion were 1) ectopic pregnancy < or = 4 cm seen by transvaginal ultrasound, 2) hCG < or = 3000 IU/l, and 3) little or no intraabdominal bleeding. In the sonography group, patients were treated by one skilled ultrasound investigator, whereas injections by laparoscopy were performed by several colleagues. The former group were offered a second glucose injection if hCG levels were rising. Those successfully treated were offered hysterosalpingography (HSG) for evaluation of tubal patency.

Results: Twenty-nine (74.4%) women were successfully treated in the sonography group by one single injection, compared to 21 (51.2%) in the laparoscopy group. Eight women in the sonography group received a second glucose injection because of a rising hCG, increasing the success rate in this group to 82.1% (32 of 39 women). Six patients in the laparoscopy group were not injected due to technical difficulties during the operation, and the success rate for those injected were 60% (21 of 35 women). The overall success rate was 66.3%. Of the 28 women investigated by HSG, both tubes were normal in 19 (67.8%), and in 25 patients (89.3%) the treated tube was open.

Conclusions: Local injection of hyperosmolar glucose guided by transvaginal ultrasound by one skilled investigator is an effective treatment for ectopic pregnancy. Most women preserve tubal patency after treatment.