Laparoscopic versus medical treatment of undisturbed ectopic pregnancy, Minia University Hospital

Introduction: The incidence of ectopic pregnancy (EP) increased almost up to a level of 2% in developed countries. Using of transvaginal ultrasonography and sensitive plasma-human chorionic gonadotropin (β-HCG) has enabled an early diagnosis before rupture. Early diagnosis allows the full range of treatment options. So, emergency surgery has been changed to a more benign condition. Administration of methotrexate (MTX) has an acceptance in selected patients and is considered costly effective with no need for waiting period before attempting another pregnancy. Although methotrexate is a teratogenic agent, its half-life is very short.
Aim of work: To evaluate the safety and efficacy of laparoscope versus MTX of well-selected cases of undisturbed ectopic pregnancy.
Materials and Methods: This is a prospective study in Minia University Hospitals during the period from March 2015 to March 2016. Forty patients of undisturbed EPs were divided randomly into two groups (20 for each group), the first group included women undergoing laparoscopic salpingostomy and the second group included women undergoing MTX. Every participant was subjected to full history taking, general, abdominal and vaginal examinations, as well as β-HCG, abdominal and vaginal ultrasound scan investigations. Only with MTX group and according to Lipscomb 2012, MTX was administrated and assessed. After full range of treatment, a close weekly follow-up of all groups was done by β-HCG level as well as abdominal and vaginal examination and ultrasonography.
Results: The mean pre-therapeutic level of β-HCG was 1081.9±655.85 mIU/ml in MTX group and 2180.75±1693.51 mIU/ml in laparoscopy group. As regarding the success rate, MTX group was 70% and not significantly different from laparoscopic 85%.
Conclusion: Undisturbed EP can be treated effectively by MTX, especially in selected cases depending mainly on β-HCG low levels pre-therapeutic and follow-up.