[Ectopic pregnancy: criteria to decide between medical and conservative surgical treatment?]

To search for criteria which should be used to decide between medical treatment and conservative laparoscopic treatment of ectopic pregnancy.

A Medline search was conducted via Pubmed and in the Cochrane Library. Other studies were selected from the references used in recent randomized trials.

Results of medical and of conservative laparoscopic treatment have been similar in patients selected for prospective randomized trials. The criteria used to include patients in these studies were determined arbitrarily. Two scores were evaluated prospectively, they included criteria which may be difficult to use in clinical practice.

The treatment should performed surgically if the patient is hemodynamically unstable, ss-hCG is >10,000 mUI/mL, the ectopic pregnancy is > or =4 cm in diameter, if there is a medical contraindication to methotrexate, and if the patient may not be followed adequately after treatment. Medical treatment should be preferred if the patient has undergone surgery many times previously, has extensive pelvic adhesion, a contraindication for general anesthesia, a cornual pregnancy, and after failure of a conservative laparoscopic treatment. Medical treatment is possible: if ss-hCG is below 5,000 or 10,000 mUI/mL, if the ectopic pregnancy is less than 4 cm in diameter or if the score is adequate when a scoring system prospectively evaluated can be used. Medical treatment should be preferred: if ss-hCG<1000 mUI/mL, if the patient has no pain and if the ectopic pregnancy cannot be visualized at ultrasound.