TREATMENT OF ECTOPIC PREGNANCY BY LOCAL INJECTION OF HYPERTONIC GLUCOSE - A RANDOMIZED TRIAL COMPARING ADMINISTRATION GUIDED BY TRANSVAGINAL ULTRASOUND OR LAPAROSCOPY

Objective. To study local treatment of ectopic pregnancy by injection of hyperosmolar (50%) glucose, guided either by transvaginal ultrasoun d or by laparoscopy. Methods. Eighty women were randomized, 39 into th e sonography and 41 into the laparoscopy group. Criteria for inclusion were 1) ectopic pregnancy less than or equal to 4 cm seen by transvag inal ultrasound, 2) hCG less than or equal to 3000 IU/1, and 3) little or no intraabdominal bleeding. In the sonography group, patients were treated by one skilled ultrasound investigator, whereas injections by laparoscopy were performed by several colleagues. The former group we re offered a second glucose injection if hCG levels were rising. Those successfully treated were offered hysterosalpingography (HSG) for eva luation of tubal patency. Results. Twenty-nine (74.4%) women were succ essfully treated in the sonography group by one single injection, comp ared to 21 (51.2%) in the laparoscopy group. Eight women in the sonogr aphy group received a second glucose injection because of a rising hCG , increasing the success rate in this group to 82.1% (32 of 39 women). Six patients in the laparoscopy group were not injected due to techni cal difficulties during the operation, and the success rate for those injected were 60% (21 of 35 women). The overall success rate was 66.3% . Of the 28 women investigated by HSG, both tubes were normal in 19 (6 7.8%), and in 25 patients (89.3%) the treated tube was open. Conclusio ns. Local injection of hyperosmolar glucose guided by transvaginal ult rasound by one skilled investigator is an effective treatment for ecto pic pregnancy. Most women preserve tubal patency after treatment.