Ectopic pregnancy: Challenging accepted management strategies
Article first published online: 29 JUL 2009
© 2009 The Author. Journal compilation © 2009 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists
Australian and New Zealand Journal of Obstetrics and Gynaecology
Volume 49, Issue 4, pages 346–351, August 2009
How to Cite
CONDOUS, G. (2009), Ectopic pregnancy: Challenging accepted management strategies. Australian and New Zealand Journal of Obstetrics and Gynaecology, 49: 346–351. doi: 10.1111/j.1479-828X.2009.01032.x
- Issue published online: 29 JUL 2009
- Article first published online: 29 JUL 2009
- Received 2 March 2009; accepted 18 May 2009.
- ectopic pregnancy;
- expectant management;
- pregnancy of unknown location;
- transvaginal ultrasound
Ectopic pregnancy is still the number one cause of maternal deaths in early pregnancy. The diagnostic capabilities of transvaginal ultrasound to confirm an EP are well founded. In fact, ultrasound technology, particularly the introduction of high-resolution transvaginal probes, has been the driving force behind the revolutionary change towards conservative management strategies in ectopic pregnancy care. Clinically stable women, however, with a scan diagnosis of a tubal ectopic pregnancy still routinely undergo surgery or are given methotrexate (MTX) at presentation. Conservative management for ectopic pregnancy may be considered in the context of clinical stability. Reassessment at 48 h allows evaluation of the trophoblast activity or ‘trophoblastic load’. Falling serum hCG levels at 48 h suggest that the ectopic trophoblast is resolving spontaneously and it may be possible to avoid methotrexate administration in this sub-group. Women with increasing serum hCG levels at 48 h, indicating the trophoblast is still active, should be targeted for methotrexate. By calculating the pre-treatment hCG ratio (hCG 48 h/hCG 0 h), it is possible to triage women with an ectopic pregnancy for conservative management. There are, however, no randomised data to support the use of MTX over expectant management. In this review, some of the current management strategies in ectopic pregnancy management will be challenged.