DIAGNOSIS AND TREATMENT OF ECTOPIC PREGNA NCY

The combined use of transvaginal ultrasound and serial quantitative de termination of the serum human chorionic gonadotropin (HCG) concentrat ion offers an early and exact diagnosis of an ectopic pregnancy before the onset of clinical symptoms. Therefore, a large variety of invasiv e and noninvasive treatment options can be chosen. In patients without severe clinical symptoms, the trophoblast activity should be determin ed via the HCG course before invasive treatment methods are performed, because a considerable proportion part of the patients show spontaneo us resolution of the ectopic pregnancy without further measures. Recen tly systemic treatment with methotrexate alone or local injection of d ifferent substances like prostaglandins, glucose, and methotrexate, et c. became an alternative to surgical therapy, i.e., endoscopic salping otomy or salpingectomy. The success rates are generally lower in compa rison to surgical therapy. Therefore, medical treatment is useful only in patients with a low trophoblast activity (e.g., <2,500 mIU/ml HCG) . However, in cases with low HCG values, observation alone frequently leads to a resolution. Corresponding to the data being available up to now, the postoperative pregnancy rate does not depend on this decisio n.