Conservative management of ectopic gestation

The management of ectopic gestation has become more challenging than ever before. The recent progress in diagnostic modalities, i.e., ultrasound and sensitive beta-hCG assays, has enabled early detection of ectopic gestation and a change in treatment goals. The traditional catastrophic presentation of a ruptured ectopic gestation and hemoperitoneum no longer is common. Today this condition is typically diagnosed before a rupture occurs, while the patient is only minimally symptomatic. Accordingly, treatment has shifted from an immediate life-saving intervention, into conservative methods of management, directed at preserving fertility and reducing morbidity. As experience is being gained rapidly in the various conservative treatment methods, their respective merits can be evaluated. Laparoscopic linear salpingostomy is the treatment of choice for small, unruptured, isthmic or ampullary gestations. Laparoscopic segmental resection is most suitable for ruptured tubal gestations. These procedures should be performed via laparotomy only if the patient is hemodynamically unstable. In selected cases, nonsurgical treatment methods, i.e., expectant management or methotrexate, may be considered. Serial serum beta-hCG measurements following a conservative treatment is mandatory to rule out persistence of trophoblastic tissue. Further prospective randomized studies are needed, to compare different conservative treatment methods in regard to their respective safety, reproductive outcome, and economic feasibility.