RANDOMIZED TRIAL OF CONSERVATIVE LAPAROSCOPIC TREATMENT AND METHOTREXATE ADMINISTRATION IN ECTOPIC PREGNANCY AND SUBSEQUENT FERTILITY

Methotrexate treatment was compared to laparoscopic salpingotomy for c onservative management of ectopic pregnancy in a prospective randomize d study. One hundred patients were randomized into two groups using ra ndom numbers. Inclusion criteria were an ectopic pregnancy visualized by ultrasound with a pre-therapeutic score <13 as assessed by the foll owing six criteria, graded from 1 to 3: gestational age, human chorion ic gonadotrophin (HCG) concentration, progesterone concentration, abdo minal pain, haemoperitoneal volume and diameter of the haematosalpinx. The treatments were either 1 mg/kg of methotrexate injected transvagi nally into the ectopic pregnancy without anaesthesia or administered i .m. when the pregnancy could not safely or easily be punctured (group 1), or laparoscopic salpingotomy (group 2), Success was defined as the return to normal (<10 mIU/ml) of HCG concentrations. Treatment was su ccessful for 45 of 51 patients in group 1 (88.2%) and 47 of 49 in grou p 2 (95.9%). Medical treatment was significantly (P < 0.05) associated with shorter postoperative stay (24 compared with 46 h), but HCG retu rned to normal more quickly after laparoscopic treatment (13 compared with 29 days). Spontaneous reproductive performance was similar in bot h groups, but overall intrauterine pregnancy was higher, and repeat ec topic pregnancy lower, after methotrexate treatment. Tn selected cases of ectopic pregnancy, with a pretherapeutic score <13, methotrexate t reatment appeared as safe and efficient as conservative treatment by l aparoscopy and was associated with improved subsequent fertility.