Diagnostic and treatment modalities for all localizations of ectopic pregnancy

Abstract

Objectives: The rate of ectopic pregnancies has increased from 0.5% in 1970 to 2% today. With the growing application of imaging techniques, however, all normal and abnormal implantations can now be detected early. This review article tries to assess a workup of all localizations of human ectopic pregnancies. Materials and Methods: All diagnostic and therapeutic modalities from the non-medical conservative method, to the medical non-surgical options through to the surgical laparoscopic approach for the treatment of ectopic pregnancies are assessed in this review. Results: Observational treatment: Monitoring HCG levels until tubal abortion or resorption is a treatment option with the risk of failure and requires patience from the patient and the treating physician. Medical treatment: The predominant drug is methotrexate but other systemic drugs, such as actinomycin D, prostaglandins and RU 486, can also be applied. Surgical treatment: In the case of tubal pregnancies, salpingotomy, partial salpingectomy followed by laparoscopic anastomosis or fimbrial milking is performed to preserve tubal function. According to their localization non-tubal ectopic pregnancies (ovarian pregnancy, ectopic abdominal pregnancy, interstitial or cornual pregnancy/rudimentary horn, intraligamental and cervical pregnancies) all require their own specific treatment. Conclusion: Today, ectopic pregnancies are diagnosed early enough to be treated effectively by laparoscopic surgery. In 5%–15% of women the remaining positive HCG values in serum after treatment refer to remnant conception products and may be treated with a final methotrexate injection or expectantly.