Seventy-five ectopic pregnancies. Medical and surgical management

The aim of this study was to evaluate the treatment options of ectopic pregnancy.

Retrospective analysis performed on 75 patients diagnosed and hospitalised with ectopic pregnancy from January 1996 to May 2001. The medical records of each patient were evaluated.

Treatment options: immediate surgical treatment (44%), methotrexate (MTX) therapy (43%) and expectant management (13%). MTX therapy success rate was 78.1%. Laparotomy was performed in 52.5% of surgically treated women. Over time there was an increase in the use of laparoscopic surgery: 75% of women underwent laparoscopy in the period 2000-2001. The rate of laparotomy still remains higher than the rate previously reported in other studies; the reason is that in our hospital no equipment for laparoscopy is available for emergency condition. Expectant management was effective when there was no pain and serum hCG levels were constantly low or were decreasing.

Technological advances allow diagnosis of ectopic pregnancy before severe clinical symptoms arise. Although early diagnosis may contribute to higher incidence, it has also contributed to a decline in morbidity, deaths, and treatment costs. Timely and early diagnosis has made this disorder amenable to medical therapy, with success rates similar to those of traditional surgical treatment. Surgery is preferred when there are tubal ruptures or a high potential for rupture, hypotension, anaemia or ectopic pregnancy which is larger than 3 cm in diameter.