Clinical Management of Ectopic Pregnancy: Observation, Surgery and Medical Therapy

Introduction The early diagnosis of ectopic pregnancy, made before the occurrence of complications linked to an hemodinamic instability, leads to a reduction of mortality from 35.5. to 3.8 per 1000 ectopic pregnancies .When the diagnosis is made, there are different therapeutic options that depend on the conditions of the patient, the β-hCG levels, the dimension of the adnexal mass, the condition of emergency, the site of the ectopic pregnancy and the compliance of the patient. The management can be surgical, medical and observational. Surgery can be performed in symptomatic patients with hemodynamic instability and clinical contraindications to Methotrexate therapy. Available surgical options for tubal pregnancy are: conservative treatment (salpingotomy), intermediate surgery (partial salpingectomy), and radical treatment (salpingectomy), usually performed by laparoscopy. Medical treatment by Methotrexate can be performed in stable, asymptomatic patient, with β-hCG values ≤ 3000-5000 mIU/mL and without ultrasonographic evidence of haemoperitoneum or fetal cardiac activity. Methotrexate therapy can be administered locally or systemically, with a fixed multiple dose or single dose regimen. The follow up of patients undergoing medical therapy consists of β-HCG evaluation until its serum level is undetectable. The proposal of a wait-and-see attitude can be made in absence of clinical symptoms, adnexal mass less than 4 cm at ultrasonographic evaluation, endopelvic free fluid less than 50 mL, low hCG levels (≤ 2000 mU/mL) and patient compliance in accepting potential complications like tubal rupture and haemorrhage. Other kinds of specific treatments are available for non tubal ectopic pregnancy. Citation: Caterina Pizzicaroli., et al. “Clinical Management Of Ectopic Pregnancy”. EC Gynaecology 1.1S1 (2016): 1-11. In the 70’s, less than 20% of ectopic pregnancies were diagnosed before rupture, so there was a high rate of morbidity and mortality linked to this disease. Nowadays, there is a more valid vigilance by clinicians. Thanks to the help of transvaginal ultrasounds and serum β-hCG levels, that lead to a progress in the diagnosis, more than 80% of ectopic pregnancies are diagnosed as intact and this let it possible to follow a conservative management. The early diagnosis made before the occurrence of complications linked to a hemodinamic instability, has lead to a reduction of mortality from 35.5. to 3.8 per 1000 ectopic pregnancies [1-5]. When the diagnosis is made, there are different therapeutic options that depend on the condition of the patient, the β-hCG level, the dimension of the adnexal mass, the condition of emergency, the site of the ectopic pregnancy and the compliance of the patient. The incidence of recurrent ectopic pregnancy is between 5% and 20% and rises up to 32% following 2 ectopic pregnancies [5]. The expected resolution time of the ectopic pregnancy is between 3 to 7 weeks after MTX application [1].