Je. Buster et Sa. Carson, ECTOPIC PREGNANCY - NEW ADVANCES IN DIAGNOSIS AND TREATMENT, Current opinion in obstetrics & gynecology, 7(3), 1995, pp. 168-176
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.