COMPARISON OF A LOCAL INJECTION OF HYPEROSMOLAR GLUCOSE SOLUTION WITHSALPINGOSTOMY FOR THE CONSERVATIVE TREATMENT OF TUBAL PREGNANCY

Objective: To compare a local injection of hyperosmolar glucose and sa lpingostomy for the laparoscopic treatment of tubal pregnancy in terms of immediate success and postoperative tubal patency. Design: Prospec tive. Patients, Setting: Forty women with an unruptured tubal pregnanc y were enrolled from among 117 women with ectopic pregnancies (EPs) ad mitted consecutively to the university clinic. The inclusion criteria were as follows: [1] concentration of beta-hCG in the serum less-than- or-equal-to 5,000 IU/L; [2] no living fetus in the EP; and [3] unruptu red tubal pregnancy at laparoscopy. Interventions: After randomization , 20 of these patients were treated with a local injection of hyperosm olar (50%) glucose solution and 20 women by salpingostomy. Tubal paten cy was evaluated at relaparoscopy or by hysterosalpingography 6 to 13 months after the primary treatment. Results: The mean decrease in beta -hCG concentration from the preoperative value to the first postoperat ive day was 37% and 52% in the glucose and salpingostomy groups, respe ctively, and the mean resolution time was 13 and 12 days, respectively . Human chorionic gonadotropin showed a persistent EP in 4 women (20%) in the glucose group and 2 (10%) in the salpingostomy group. A patent treated tube was found in 9 of 13 women in the glucose group and 9 of 10 in the salpingostomy group at re-examination. During a follow-up o f 6 to 20 months 4 women in the glucose group and 4 women in the salpi ngostomy group had an intrauterine pregnancy. Conclusion: A local inje ction of hyperosmolar glucose is a reasonable method treating tubal pr egnancy in selected cases but does not seem to offer any advantage ove r salpingostomy concerning persistent trophoblastic disease rate.