DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20172931

Non-surgical management of unruptured tubal ectopic pregnancy

Anjali Choudhary, Priyanka Chaudhari, Neeta Bansal

Abstract


Background: Ectopic pregnancy is still the leading cause of pregnancy related morbidity in the first trimester. Since majority of the women who present with ectopic pregnancies are sub fertile and young, there is a role for non-surgical options of managing these pregnancies. Expectant and medical management not only serves to conserve the fallopian tubes but also saves women from surgical trauma and morbidity. The objective of this retrospective study was to share our experience of treating un-ruptured tubal ectopic pregnancies conservatively.

Methods: Women diagnosed with un-ruptured tubal ectopic pregnancy, fit for conservative /medical management were included. Women with serum beta HCG levels less than 1000 mIU/L were treated expectantly and women with Bet HCG levels >1000 but <10,000 mIU /L were given Injectable methotrixate. Response to treatment was monitored by serial beta HCG levels.

Results: Total 37 women included in the study.12% women showed complete resolution with expectant treatment alone and 88% resolved after a single dose methotrixate.

Conclusions: Many women with un-ruptured tubal ectopic pregnancies would benefit from expectant management, or methotrixate therapy. Methotrixate used in carefully selected women is safe and effective in resolving these cases with good post treatment reproductive outcome.


Keywords


Conservative treatment, Ectopic pregnancy, Medical management

Full Text:

PDF

References


Chi TJ, Dyne PL. Emergent Management of Ectopic Pregnancy. Available at http://emedicine.medscape.com/article/796451-overview.

Majhi AK, Roy N, Karmakar KS, Banerjee PK. Ectopic pregnancy--an analysis of 180 cases. Journal of the Indian Medical Association. 2007;105(6):308-10.

Harrison-Woolrych M, Woolley J. Progestogen-only emergency contraception and ectopic pregnancy [editorial]. J Fam Plann Reprod Health Care. 2003;29(1):5-6.

Canis M, Savary D, Pouly JL, Wattiez A, Mage G. Ectopic pregnancy: criteria to decide between medical and conservative surgical treatment? J Gynecol Obstet Biol Reprod (Paris). 2003;32(7Suppl):S54-63.

Pereira PP, Cabar FR, Raiza LC, Roncaglia MT, Zugaib M. Emergency contraception and ectopic pregnancy: report of 2 cases. Clinics. 2005;60(6):497-500.

Barnhart KT, Gosman G, Ashby R, Sammel M The medical management of ectopic pregnancy: a meta-analysis comparing single dose and multidose regimens. Obstet Gynecol. 2003;101(4):778-84.

Guvendag Guven ES, Dilbaz S, Dilbaz B, Aykan Yildirim B, Akdag D, Haberal A. Comparison of single and multiple dose methotrexate therapy for unruptured tubal ectopic pregnancy: a prospective randomized study. Acta obstetricia et gynecologica Scandinavica. 2010;89(7):889-95.

Alshimmiri MM, Al-Saleh EA, Al-Harmi JA, AlSalili MB, Adwani AA, Ibrahim ME. Treatment of ectopic pregnancy with a single intramuscular dose of methotrexate. Arch Gynecol Obstet. 2003;268(3):181-3.

Slaughter JL, Grimes DA. Methotrexate therapy. Nonsurgical management of ectopic pregnancy West J Med. 1995;162(3):225-8. PMCID: PMC1022704

Soliman KB, Saleh NM, Omran AA. Safety and efficacy of systemic methotrexate in the treatment of unruptured tubal pregnancy. Saudi Med J. 2006;27(7):1005-10.

Arora P. Ectopic pregnancy after progesterone only emergency contraception, contraception for women: an evidence based overview. BMJ ed-letter to editor. 2013.