ECTOPIC PREGNANCY - NEW ADVANCES IN DIAGNOSIS AND TREATMENT

Recent reports affirm that ectopic pregnancy has become a medical rath er than a surgical disease. Early diagnosis is the key to effective no nsurgical treatment. Diagnostic algorithms using serum progesterone, s erial beta-human chorionic gonadotropin measurements, ultrasound, and office curettage now make definitive diagnosis possible without laparo scopy. Laparoscopic salpingostomy, the surgical gold standard, is an e ffective therapy but carries surgical complications and is expensive. Systemic variable dose methotrexate produces outcomes close to laparos copic salpingostomy in similar patients. Single dose systemic methotre xate and intratubal methotrexate appear to be less effective. In many cases, ectopic pregnancies do not meet suitable medical criteria and s till require surgery. The challenge today is identifying patients at r isk and bringing them into the system during the early first trimester when treatment is simple.