[Pharmacological treatment of ectopic pregnancy]

The incidence of ectopic pregnancies (EP), has increased significantly in the past 20 years. Conservative tubal surgery has long been the treatment of choice. However, non-surgical treatment of EP has recently become an alternative to surgery. This pharmacological approach uses chiefly methotrexate but attempts have been reported using prostaglandins, actinomycin D, potassium chloride, mifepristone and anti-hCG monoclonal antibodies. Early diagnosis and close follow-up of EP by methods including transabdominal and transvaginal ultrasound examination and serial measurements of hCG allow to choose the more appropriate treatment of EP. The present article gives an overview of the pathophysiology of EP, followed by a review of the various pharmacological treatments available. This review is centered on methotrexate as the best known drug in this indication. Published data on local and general tolerance, efficacy and pharmacokinetics are reviewed. A pretherapeutic assessment score using six criteria is also discussed, the objective of which is to better define the surgical and non-surgical indications. The non-surgical treatment of EP can provide a safe and effective alternative to surgical treatment. However, further studies are needed to assess the effects of these pharmacological treatments on both fertility and risk of recurrence of EP.