Ectopic pregnancy: laparoscopic and medical treatment

Today ectopic pregnancies can be recognized before the appearance of dramatic symptoms, mainly because of improved diagnostic methods, eg, endovaginal sonography and serial human chorionic gonadotropin determinations. The condition can therefore be treated by more elegant methods and emergency laparotomy is seldom indicated. A variety of new surgical modalities have been introduced during recent years: laparoscopic salpingotomy, tubal resection, or salpingectomy. Large-scale trials have documented the advantages of the techniques in terms of operative time, hospitalization, and convalescence, although the risk for retained trophoblast may be increased. Systemic medical treatment with methotrexate is effective in approximately 95% of cases. In addition, minimally invasive methods such as local medical therapy have been designed: transabdominal, transvaginal, and transuterine injection of compounds such as prostaglandins, methotrexate, and hyperosmolar glucose. So far, large-scale, randomized trials are lacking and the techniques should still be considered investigational.