[Ectopic pregnancy. Non-surgical management. 4-year retrospective study]

The nonsurgical management of 80 women with unruptured ectopic pregnancies admitted to a facility in Barranquilla Colombia between June 1989 and September 1993 was retrospectively studied. 20 women with an initial HCG level no higher than 2500 U/L that remained stable or declined on the third day and absence of fetal heart beat received expectant management. The other 60 who had HCG levels no greater than 25000 U/L and presence or absence of fetal heart beat were treated with intraamniotic methotrexate injection. The maximum diameter for both groups was 2 cm on transvaginal ultrasound. The protocol for expectant management involved initial determination of HCG hemogram an ultrasound diagnosis repeat determination of HCG on the third day weekly determinations of HCG and hemogram until the fifth week and repeat ultrasound diagnosis at the fifth week. The protocol for methotrexate injection required initial HCG determination ultrasound diagnosis and hemogram liver function tests initially and two weeks after injection weekly HCG determinations through the fifth week and periodic repeat ultrasound studies. In the final study year Color-Doppler of trophoblastic flow was added. The intraamniotic methotrexate dose varied between 25 mg and 100 mg depending on patient weight and pregnancy size. Only one of the 20 receiving expectant treatment showed a significant increase in HCG levels and elected to undergo microsurgery by laparotomy. Hysterosalpingography to confirm tubal permeability was performed in 12 of the 19 and was positive in 11. 11 of the 19 women later had intrauterine pregnancies. Among the 60 women receiving methotrexate injections only one required immediate surgery for bleeding. This case was the first in the series and had the highest HCG level at 25000 U/L and the largest size. The average HCG level for the 60 patients was 4523 U/L in the first week and less than 20 in the fifth week. Few secondary effects of methotrexate injection were observed. Hysterosalpingography showed tubal permeability in 37 of 41 cases. 22 of the 37 women later achieved intrauterine pregnancies and one had a repeat ectopic pregnancy.