Document Detail


Endoscopic management of ectopic pregnancy.
MedLine Citation:
PMID:  7882621     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The rationale for the conservative management of ectopic pregnancy is the preservation of reproductive potential. Removal of trophoblast through a linear incision (salpingotomy) can be easily performed by endoscopy. The injection of vasopressin into the broad ligament is required in less than 10% of cases and its routine use is not recommended because of the risk of severe side-effects. The techniques in cases of isthmic or cornual tubal pregnancy are also described. Other alternatives such as expectant management, methotrexate, RU 486 and prostaglandins have also recently been proposed. Although methotrexate therapy has been demonstrated to be effective in cases of unruptured tubal pregnancy, further studies are needed to determine whether or not this medical therapy is a safer option than laparoscopic surgery and to compare the subsequent intrauterine and recurrent ectopic pregnancy rates. Endoscopic salpingotomy is an efficacious procedure. Indeed, residual trophoblast is found in only 5% of cases after this surgical procedure. In these cases of persistent trophoblast, methotrexate is proposed as the medical approach of choice. Evaluation of the postoperative fertility after linear salpingotomy demonstrates an intrauterine pregnancy rate of 63% and a recurrent ectopic pregnancy rate of 8%. In conclusion, endoscopic management of tubal pregnancy is a safe and efficacious therapy. The contraindications are relative and depend essentially on the surgeon's experience.
Authors:
J Donnez; M Nisolle
Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Baillière's clinical obstetrics and gynaecology     Volume:  8     ISSN:  0950-3552     ISO Abbreviation:  Baillieres Clin Obstet Gynaecol     Publication Date:  1994 Dec 
Date Detail:
Created Date:  1995-04-13     Completed Date:  1995-04-13     Revised Date:  2005-11-16    
Medline Journal Info:
Nlm Unique ID:  8710782     Medline TA:  Baillieres Clin Obstet Gynaecol     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  707-22     Citation Subset:  IM    
Affiliation:
Department of Gynaecology, Cliniques Universitaires St Luc, Catholic University of Louvain, Brussels, Belgium.
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MeSH Terms
Descriptor/Qualifier:
Female
Humans
Laparoscopy*
Methotrexate / therapeutic use
Postoperative Care
Pregnancy
Pregnancy, Ectopic / pathology,  surgery*,  therapy
Trophoblasts
Chemical
Reg. No./Substance:
59-05-2/Methotrexate

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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