Conservative medical and surgical management of interstitial ectopic pregnancy

Objective: To review the definition and diagnosis of interstitial and heter otopic interstitial pregnancy and to evaluate the conservative management o f these conditions. Design: A MEDLINE computer search was used to identify relevant studies. Th e mean values for the duration of amenorrhea, serum beta-hCG level, size of the ectopic mass, and success rates of the various treatment modalities we re calculated from the raw data in the original publications. Result(s): A review of 41 patients with interstitial pregnancy who were tre ated with methotrexate systemically, locally, or in combination revealed an overall success rate of 83%. The mean duration of amenorrhea, mean serum b eta-hCG level, and mean size of the ectopic mass were 54 days, 15,127 mIU/m L, and 23 mm, respectively. Among 22 patients with interstitial pregnancy w ho were treated with conservative laparoscopic techniques, the overall succ ess rate was 100%. In this group, the mean duration of amenorrhea, mean ser um beta-hCG level, and mean size of the ectopic mass were 54 days, 7,572 mI U/mL, and 31 mm, respectively. There were nine cases of heterotopic interst itial pregnancy. Seven patients were managed with potassium chloride inject ed into the ectopic pregnancy, and two patients were treated by laparoscopy . Overall, 67% of the coexisting intrauterine pregnancies resulted in succe ssful deliveries and the remainder ended in spontaneous abortions. Conclusion(s): Cornual resection or hysterectomy with a laparotomy should n o longer be the first line of treatment for a hemodynamically stable patien t with an interstitial pregnancy. In selected cases, methotrexate and lapar oscopy can be used successfully in treating early interstitial pregnancy. ( C) 1999 by American Society far Reproductive Medicine.