Ectopic pregnancy: let's cut! Strict laparoscopic approach to 194 consecutive cases and review of literature on alternatives
K. Clasen, M. Camus, H. Tournaye, P. Devroey
cases of ectopic examination, coupled with human chorionic gonadotrophin (HCG) pregnancy were diagnosed in our centre and treated followassessment, either in urine or in serum, and transvaginal ultrasound. ing a strict laparoscopic protocol. A total of 193 cases was In a minority of cases a diagnostic curettage was performed to exclude treated surgically and only one case was treated medically, the presence of intrauterine trophoblastic tissue. because general anaesthesia was contraindicated.
... to- Surgical intervention was performed under general anaesthesia, on gether, eight laparotomies (4.1%) had to be performed; an in-patient basis, either by or under the direct supervision of a three primary and five secondary, due to uncontrollable senior staff member of the Centre for Reproductive Medicine. Time haemorrhage (n ⍧ 3) and too large pregnancy size (n ⍧ 2). of surgery was either at the moment of diagnosis, in case of emergency, or otherwise the next morning, as part of the routine operative Peri-or postoperative complications were encountered in programme. cases (12.4%). Residual disease occurred in 14 cases Postoperative follow-up consisted of serial HCG assessment (twice (7.2%), all after a technically successful operative laparoweekly) until complete negativity (Ͻ5 IU/l). scopic procedure. These cases received adjuvant therapy, In the case of medical adjuvant therapy, methotrexate was systemateither systemic administration of methotrexate or a second ically administered i.m. at a dosage of 1 mg/kg body weight, on an intervention. The overall laparoscopic cure rate was 88.1% out-patient basis, to be repeated after 48 h, if necessary, under (171/194). Conclusive follow-up data could be obtained citrovorum rescue and haematological monitoring. concerning 110 cases with an active desire for pregnancy. Overall conception rate was 77.3%, with an ongoing preg-Results nancy rate of 81.2% and a recurrency rate of 10.6%. A Patients critical overview of the available data on non-surgical In all, 185 women presented a total of 194 consecutive ectopic approaches is made, while the reported results are evaluated pregnancies from March 1989 till December 1995. During according to published data. It is concluded that at this this observation period five women had one repeat ectopic stage a surgical approach by means of operative laparospregnancy, while two presented with two recurrences, the copy should remain the gold standard in treating ectopic remaining 178 having a single ectopic pregnancy. pregnancies. Mean maternal age at the moment of diagnosis was 31.3