|Diagnostic and Treatment Modalities for All Localizations of Ectopic Pregnancy|
|Ibrahim Alkatout1, Ulrich Honemeyer2, Karl-Günter Noé3, Christel Eckmann-Scholz1, Nicolai Maass1, Mohamed Elessawy1, Liselotte Mettler1|
|1Department of Gynecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller Strasse, Kiel, Germany
2Fetal Medicine and Genetics Center, Dubai Healthcare City, Dubai, UAE
3Department of Obstetrics and Gynecology, Dormagen District Hospital, Dr.-Geldmacher-Str. Dormagen, Germany
IJWHR 2017; 5: 082-089
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Keywords : Ectopic pregnancy, Laparoscopy, Methotrexate, Tubal function, Non-tubal ectopic pregnancy, Early diagnosis, Individualized treatment
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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.
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