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Abstract
The decision to manage an ectopic pregnancy surgically will depend on the likelihood of success of non-surgical treatment. Since medical therapy is less likely to succeed, surgery is the preferred approach for ectopic pregnancy when there are signs of cardiac activity and -hCG concentrations are greater than 5000 IU/L.62,63 Other indications for surgery include an adnexal mass greater than 4 cm in diameter and free fluid in the pelvis on transvaginal ultrasound.
Open or laparoscopic surgery?
The choice of open or laparoscopic surgery will depend on whether the patient is haemodynamically stable. In women with no signs of shock, laparoscopic surgery is generally favoured over laparotomy.
Local treatment is likely to minimize any side effects associated with systemic therapy, The most important selection criterion for nonsurgical management of ectopic pregnancy is an unruptured pregnancy in a hemodynamically stable patient. one should still choose an agent based on the patient’s past medical history. For example, Prostaglandins (PGs) are contraindicated in asthmatics due to their bronchoconstrictive potential . Given its side effect profile, The American College of Obstetricians and Gynecologists has suggested that MTX should be avoided in the setting of compromised renal or hepatic function, immunocompromised patients, women who are breastfeeding, blood dyscrasias, active pulmonary disease, and peptic ulcer disease, although they did not specify local versus systemic treatment. In patients with such contraindications, other agents such as potassium chloride or hyperosmolar glucose are better options.
Fertility after an ectopic pregnancy depends on how that pregnancy was managed and on the presence or absence of known risk factors.
Approximately 30 percent of women treated for ectopic pregnancy later have difficulty conceiving. The overall conception rate is approximately 77 percent regardless of treatment.