Tubal pregnancy in adolescence

Fourteen women under age 19 were evaluated and treated for ectopic pregnancy at the Regional Medical Center, Memphis. These women were screened according to a protocol involving use of quantitative beta-human chorionic gonadotropin (beta hCG) and serum progesterone levels. All patients were in the first trimester of pregnancy, with a mean gestational age of 8.5 weeks based on menstrual dating. Ten patients denied knowing that they were pregnant prior to this evaluation. Because of the patients symptoms and clinical signs, nine patients underwent diagnostic laparoscopy at the time of initial evaluation. Of these, seven underwent either salpingectomy or salpingostomy for a ruptured ectopic pregnancy or ectopic greater than 3 cm in greatest dimension. Two patients were successfully treated without surgery. Five patients were discharged after their initial evaluation and were identified only by abnormal values on serial determinations of beta hCG and progesterone. One required salpingostomy, and the other four were successfully treated with methotrexate. Ectopic pregnancies identified at an early gestational age and prior to rupture are amenable to conservative treatment with methotrexate or laproscopic surgery. Patients who were identified by the protocol and not by clinical signs and symptoms were more likely to be candidates for conservative therapy.