Ectopic pregnancy management by a non invasive protocol

The hemodynamic stable patient suspected of extrauterine pregnancy may be a diagnostic challenge. Dilatations and curettage, Douglas puncture and laparoscopy are significant diagnostic aid in the investigation of the suspected ectopic pregnancy patient; but they are among the invasive methods. The introduction of non invasive methods such as serum beta subunit hCG and sophisticated ultrasound techniques seems to institute a more conservative approach to the "stable patient" prior to exposing her to anaesthetic and operative risks. A prospective study on "stable patients" suspected of "subacute" extrauterine pregnancy was undertaken in order to assess the diagnostic usefulness of a suggested non invasive protocol to determine whether its use has an advantage over the traditional invasive methods. 108 patients were evaluated in this study. 31 women were managed according to the non invasive protocol; patients presenting positive sonography signs underwent immediate operative procedure, patients in whom sonography revealed suggestive signs of E.U.P., expectant management was undertaken till serum beta subunit hCG confirmed or excluded the diagnosis. 77 patients were managed according to the invasive method protocol. Results indicate that the non invasive protocol has high diagnostic accuracy. Among the 31 patients no unnecessary intervention was performed. On the other hand, among the 77 patients, 43 laparoscopies were unnecessary.