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Human Reproduction Update, Vol.2, No.6 pp.541-551, 1996
© European Society of Human Reproduction and Embryology 1996; all rights reserved

Controversies and problems in the current management of tubal pregnancy

R Maymonz and A Shulman

Departments of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Tzrifin and Chaim Sheba Medical Center, Tel Hashomer (affiliated with the Sackler Faculty of Medicine, Tel Aviv), Israel z Corresponding author

Abstract

The two main conservative treatment alternatives for tubal pregnancy, methotrexate administration and laparoscopic salpingostomy are under constant review. Recently, expectant management of tubal pregnancy has become increasingly popular. In this review, we assess the outcome of conservative management modalities for treatment with methotrexate and operative laparoscopy. Outcomes of extrauterine pregnancy were obtained from a review compiled from the English literature identified by directed Medline search. Methotrexate and laparoscopic salpingostomies yield good final treatment rates of 85-95% respectively and relatively low rates for further surgical complication (5-10% respectively). Tubal patency, as well as future fertility performance, are quite similar after both techniques. Although they appear to suit the demands of the 21st century, each one has its own benefits and contraindications. With adequate patient selection, expectant management of the tubal pregnancy is a reasonable approach with good results. Although the morbidity rate after tubal pregnancy treatment is decreasing and the main concern is to reduce the decline in fertility potential, the real future challenge remains prevention of the disease, especially among the high risk patients, such as those undergoing infertility treatment.

Keywords: assisted reproductive techniques/conservative treatment/methotrexate/operative laparoscopy/tubal pregnancy


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