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Laparoscopic prostaglandin injection in ectopic pregnancy: success rates according to endocrine activity
G Paulsson1, S Kvint, B M Labecker
1Central Hospital, County of Skaraborg, Skövde, Sweden.
Objective:
To investigate the clinical performance of local prostaglandin treatment of ectopic pregnancies (EPs) in relation to their biologic activity as determined by preoperative serum hCG levels.
Design:
Prospective study over a 2-year period of 108 patients with 127 tubal pregnancies.
Setting:
A department of obstetrics and gynecology in a central county hospital.
Patients:
One hundred eight patients who presented with a clinical diagnosis of EP.
Interventions:
Patients with EP were treated with laparoscopy-guided injection of prostaglandin F2 alpha in the surrounding tubal wall and the corpus luteum-bearing ovary. All members of the staff participated.
Main Outcome Measures:
Success rate, hospitalization cost, and convalescence period.
Results:
Seven laparotomies (7.5%) were performed postoperatively due to increasing hCG levels or ruptures with circulatory reactions. All except one had an initial (preoperative) hCG value > 1,000 mIU/mL (conversion factor to SI unit, 1.00). The mean hospitalization period was 2.7 days and 90% of the medically treated patients returned home on the first postoperative day. The mean convalescence period was 18 days.
Conclusion:
The procedure is simple and carries an acceptable success rate in cases with hCG levels < 1,000 mIU/mL. The approach demands minimal technical resources and it may reduce health care costs substantially.