Local treatment of ectopic pregnancy

The treatment of ectopic pregnancies has evolved from a purely surgical route with routine removal of the fallopian tube to one with multiple options. Medical treatment can be administered systemically or via local injection. Local delivery of chemotherapeutic agents is a safe and proven modality that is especially indicated for pregnancies in which a laparoscopic approach is not ideal and systemic therapy either has failed or is not desired. Local therapy has the potential to document immediately the cessation of fetal heart activity. Nontubal ectopic pregnancies may be ideally suited to local therapy, especially when there is a fetal heart present. Transvaginal ultrasound is the preferred mode for guidance and laparoscopic guidance has a limited role. Although a multitude of agents have been proposed, methotrexate, KCl, and hyperosmolar glucose are the most widely used and readily available. Local therapy has an important place in the armamentarium of the treatment of ectopic pregnancies.