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Medicine Supplement 3 · 2015 · pp. 284–294 · Issue page

MEDICAL VS. INTERVENTIONAL THERAPY FOR ECTOPIC PREGNANCY

DI
Diana Voicu1
RO
Roxana Bohaltea2
MO
Monica Carstoiu et all3
Accepted 28 March 2026
Available Online 15 July 2015
Abstract
ECTOPIC PREGNANCY REMAINS AN IMPORTANT CAUSE OF MATERNAL MORBIDITY AND MORTALITY. THE FREQUENCY OF ECTOPIC PREGNANCY VARIES BETWEEN 0.58 AND 1.3 %. CERVICAL ECTOPIC PREGNANCY IS VERY RARE (0.1% OF ALL EXTRA -UTERINE PREGNANCIES). MOST ECTOPIC PREGNANCIES ARE LOCATED IN THE FALLOPIAN TUBES, AND IN LESS THAN 5% OF ECTOPIC PREGNANCIES, THE IMPLANTATION IS IN THE CERVIX, OVARIES, OR THE ABDOMINAL CAVITY. THIS ARTICLE REVIEWS THE MODERN MEDICAL AND ENDOVASCULAR THERAPEUTIC APPROACH OF UNCOMPLICATED AND COMPLICATED ECTOPIC PREGNANCY.
Keywords
ECTOPIC PREGNANCY METHOTREXATE ENDOVASCULAR THERAPY.
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References
[1]
ACOG technical bulletin No. 3. 1998. Medical management of tubal pregnancy. Clinical m anagement guidelines for obstetrician -gynecologists. American College of Obstetricians and Gynecologists. Int J Gynaecol Obstet. 1999;65:97-103.
[2]
Shaw, Julie LV, Fiona C. Denison, Jemma Evans, Kimberley Durno, Alistair R. Williams, Gary Entrican, Hilary OD Critchley, Henry N. Jabbour, and Andrew W. Horne . "Evidence of prokineticin dysregulation in fallopian tube from women with ectopic pregnancy." Fertility and sterility 94, no. 5 (2010): 1601-1608.
[3]
Goldner, Tatiana E., Herschel W. Lawson, Zhisen Xia, and Ha ni K. Atrash. "Surveillance for ectopic pregnancy—United States, 1970–1989." MMWR CDC Surveill Summ 42, no. 6 (1993): 73-85.
[4]
Varma, Rajesh, and Janesh Gupta. "Tubal ectopic pregnancy." Clinical evidence 2009 (2009).
[5]
Ushakov, Fedor B., Uriel Elchalal, Paul J. Aceman, and Joseph G. Schenker. "Cervical pregnancy: past and future." Obstetrical & gynecological survey 52, no. 1 (1997): 45-59.
[6]
National Institute for Clinical Excellence. "Why women die. Report on confidential enquiries into maternal deaths in the United Kingdom, 1997–1999." (2001).
[7]
Kirsch, Jonathan D., and Leslie M. Scoutt . "Imaging of ectopic pregnancy." Applied Radiology 39, no. 3 (2010): 10.
[8]
Levi CS, Lyons EA. The first trimester. In: Rumack CM, Wilson SR, Charboneau JW, Levine D, editors. Diagnostic Ultrasound. 4th ed. Chapter 30. Philadelphia: Elsevier; 2011. pp. 1099–110.
[9]
Bouyer, Jean, Joël Coste, Taraneh Shojaei, Jean-Luc Pouly, Hervé Fernandez, Laurent Gerbaud, and Nadine Job -Spira. "Risk factors for ectopic pregnancy: a comprehensive anal ysis based on a large case -control, population -based study in France." American Journal of Epidemiology 157, no. 3 (2003): 185-194.
[10]
American College of Obstetricians and Gynecologists. "ACOG Practice Bulletin No. 101: Ultrasonography in pregnancy." Obstetrics and Gynecology 113, no. 2 Pt 1 (2009): 451.
[11]
Barnhart, Kurt T., Mary D. Sammel, Clarisa R. Gracia, Jesse Chittams, Amy C. Hummel, and Alka Shaunik. "Risk factors for ectopic pregnancy in women with symptomatic first -trimester pregnancies." Fertility and sterility 86, no. 1 (2006): 36-43.
[12]
Breen JL, A 21 year survey of 654 ectopic pregnancies, Am J Obstet Gynecol 106:1004, 1970
[13]
Bouyer, Jean, Joël Coste, Hervé Fernandez, Jean -Luc Pouly, and Nadine Job -Spira. "Sites of ectopic pregnancy: a 10 year populat ion-based study of 1800 cases." Human Reproduction 17, no. 12 (2002): 3224-3230.
[14]
Dart, Robert G., Beth Kaplan, and Kalli Varaklis . "Predictive value of history and physical examination in patients with suspected ectopic pregnancy." Annals of emergency medi cine 33, no. 3 (1999): 283-290.
[15]
Buckley, Robert G., Kerry J. King, Jeffrey D. Disney, John D. Gorman, and Jack H. Klausen . "History and physical examination to estimate the risk of ectopic pregnancy: validation of a clinical prediction model." Annals of emergency medicine 34, no. 5 (1999): 589-594.
[16]
Silva, Celso, Mary D. Sammel, Lan Zhou, Clarisa Gracia, Amy C. Hummel, and Kurt Barnhart. "Human chorionic gonadotropin profile for women with ectopic pregnancy." Obstetrics & Gynecology 107, no. 3 (2006): 605-610.
[17]
Kadar, N., M. Bohrer, E. Kemmann, and R. Shelden . "The discriminatory human chorionic gonadotropin zone for endovaginal sonography: a prospective, randomized study." Fertility and sterility 61, no. 6 (1994): 1016-1020.
[18]
Spandorfer, S. D., and K. T. Bar nhart. "Endometrial stripe thickness as a predictor of ectopic pregnancy." Fertility and sterility 66, no. 3 (1996): 474-477.
[19]
Seeber, Beata, Mary Sammel, Lan Zhou, Amy Hummel, and Kurt T. Barnhart . "Endometrial stripe thickness and pregnancy outcome in fi rst-trimester pregnancies with bleeding, pain or both." The Journal of reproductive medicine52, no. 9 (2007): 757-761.
[20]
Cartwright P, DiPietro D . Beta HCG is a diagnostic and for suspected ectopic pregnancy. Obstet Gynecol. 1984; 63:76
[21]
Carson SA,Buster JE: Ectopic pregnancy.N Engl J Med 329: 1174,1993
[22]
Hubinont, Corinne J., Christine Thomas, and Jean F. Schwers . "Luteal function in ectopic pregnancy." American journal of obstetrics and gynecology 156, no. 3 (1987): 669-674.
[23]
Wang, Lingjia, Graham M. Warnes, C hristine A. Kirby, Colin D. Matthews, and Robert J. Norman. "Luteal function associated with single, multiple and ectopic embryo implantation in natural July 2015 cycles or after ovarian hyperstimulation for in -vitro fertilization/gamete intra -Fallopian transfer." Human Reproduction 5, no. 4 (1990): 476-480.
[24]
Mantzavinos, Themis, Iphigenia Phocas, Haralambos Chrelias, Angeliki Sarandakou, and Pantelis A. Zourlas. "Serum levels of steroid and placental protein hormones in ectopic pregnancy." European Journal of Obstetrics & Gynecology and Reproductive Biology 39, no. 2 (1991): 117-122.
[25]
Lower, A. M., J. L. Yovich, C. Hancock, and J. G. Grudzinskas . "Is luteal function maintained by factors other than chorionic gonadotrophin in early pregnancy?." Human Reproduction 8, no. 4 (1993): 645-648.
[26]
Stovall TG, Ling FW, Andersen RN, Buster JE , Improved sensitivity and specificity of a single measurement of serum progesterone over serial quantitative beta -human chorionic gonadotrophin in screening for ectopic pregnancy, Hum Reprod 7:723, 1992
[27]
Gelder, M. S., L. R. Boots, and J. B. Younger . "Use of a single random serum progesterone value as a diagnostic aid for ectopic pregnancy." Fertility and sterility 55, no. 3 (1991): 497-500.
[28]
McCord, M. L., D. Muram, J. E. Buster, K. L. Arhear t, T. G. Stovall, and S. A. Carson . "Single serum progesterone as a screen for ectopic pregnancy: exchanging specificity and sensitivity to obtain optimal test performance."Fertility and sterility 66, no. 4 (1996): 513-516.
[29]
Fernandez, Hervé, SC Yves Vincen t, Sylvie Pauthier, François Audibert, and René Frydman . "Randomized trial of conservative laparoscopic treatment and methotrexate administration in ectopic pregnancy and subsequent fertility."Human Reproduction 13, no. 11 (1998): 3239-3243.
[30]
Kenigsberg, Da niel, J. Porte, M. Hull, and I. M. Spitz . "Medical treatment of residual ectopic pregnancy: RU 486 and methotrexate." Fertility and sterility 47, no. 4 (1987): 702-703.
[31]
Altaras, M., I. Cohen, M. Cordoba, I. BEN ‐NUN, and N. BEN ‐ADERET. "Treatment of an interstitial pregnancy with actinomycin D. Case report." BJOG: An International Journal of Obstetrics & Gynaecology 95, no. 12 (1988): 1321-1323.
[32]
Aboulghar, M. A., R. T. Mansour, and G. I. Serour. "Transvaginal injection of potassium chloride and methotrexate for the treatment of tubal pregnancy with a live fetus." Human Reproduction 5, no. 7 (1990): 887-888.
[33]
Lang, PeterF, PeterA M. Weiss, HanzO Mayer, JosephG Haas, and Werner Hönigl. "Conservative treatment of ecto pic pregnancy with local injection of hyperosmolar glucose solution or prostaglandin-F 2 α: a prospective randomised study." The Lancet 336, no. 8707 (1990): 78-81.
[34]
Lang, PeterF, PeterA M. Weiss, HanzO Mayer, JosephG Haas, and Werner Hönigl . "Conservative treatment of ectopic pregnancy with local injection of hyperosmolar glucose solution or prostaglandin-F 2 α: a prospective randomised study." The Lancet 336, no. 8707 (1990): 78-81.
[35]
Gazvani, M. Rafet, and Simon J. Emery . "Mifepristone and methotrexate: Th e combination for medical treatmentof ectopic pregnancy." American journal of obstetrics and gynecology 180, no. 6 (1999): 1599-1600.
[36]
Mukul, Liberato V., and Stephanie B . Teal. "Current management of ectopic pregnancy." Obstetrics and gynecology clinics of North America 34, no. 3 (2007): 403-419.
[37]
Calabresi P, Chabner BA. Antineoplastic agents. In: Gilman A, Goodman LS, Goodman A (eds), The Pharmacologic Basis of Therapeutics (8th edn). New York, NY: Macmillan Publishing, 1275 – 12761990;
[38]
Bischoff, K. B., R. L. Dedrick, D. S. Zaharko, and J. A. Longstreth . "Methotrexate pharmacokinetics." Journal of pharmaceutical sciences 60, no. 8 (1971): 1128-1133..
[39]
Zachariae, H. "Methotrexate side ‐effects." British Journal of Dermatology 122, no. s36 (1990): 127 - 133.
[40]
Stovall, Thomas G., and Frank W. Ling. "Single-dose methotrexate: an expanded clinical trial." American journal of obstetrics and gynecology 168, no. 6 (1993): 1759-1765.
[41]
Kooi, Sjarlot, and HANS CLV KOCK . "A review of the literature on nonsurgical treatment in tubal pregnancies." Obstetrical & gynecological survey 47, no. 11 (1992): 739-749.
[42]
Lipscomb, Gary H., Marian L. McCord, Thomas G. Stovall, Genelle Huff, S. Greg Portera, and Frank W. Ling. "Predictors of success of methotrexate treatment in women with tuba l ectopic pregnancies." New England Journal of Medicine 341, no. 26 (1999): 1974-1978.
[43]
American College of Obstetricians and Gynecologists , Prevention of Rh D isoimmunization, in Practice Bulletin. 1999, AmericanCollege of Obstetricians and Gynecologists: Washington, DC.
[44]
Fung, Kee Fung K., Erica Eason, J. Crane, A. Armson, S. De La Ronde, D. Farine, L. Keenan - Lindsay et al. "Prevention of Rh alloimmunization." Journal of obstetrics and gynaecology Canada: JOGC= Journal d'obstetrique et gynecologie du Canada: JOGC 25, no. 9 (2003): 765-773.
[45]
Della-Giustina D, Denny M. Ectopic pregnancy. Emerg Med Clin North Am 2003;21:565–584. Supplement No. 3/2015
[46]
Barnhart, Kurt T., Gabriella Gosman, Rachel Ashby, and Mary Sammel . "The medical management of ectopic pregnancy: a meta -analysis com paring “single dose” and “multidose” regimens." Obstetrics & Gynecology 101, no. 4 (2003): 778-784.
[47]
Irina-Adriana Horhoianu , Vasile -Valerică Horhoianu, Daniela Joiţa, Bogdan Dorobăţ, Monica Cîrstoiu- Embolization in cervical ectopic pregnancy. Revista Ginecologia. Ro, Anul II , Nr. 3 (1/2014)
[48]
Spies, James B., Antoinette R. Roth, Reena C. Jha, Jackeline Gomez -Jorge, Elliot B. Levy, Thomas C. Chang, and Susan A. Ascher . "Leiomyomata Treated with Uterine Artery Embolization: Factors Associated with Successful Symptom and Imaging Outcome 1." Radiology 222, no. 1 (2002): 45-52.
[49]
Pelage, Jean -Pierre, Woodruff J. Walker, Olivier Le Dref, Alexandre Laurent, and Roland Rymer. "Treatment of uterine fibroids." Lancet 357, no. 9267 (2001): 1530.
[50]
Katsumori, Tetsuya, Kazuhiro Nakajima, and Tadashi Mihara . "Is a large fibroid a high -risk factor for uterine artery embolization?." American Journal of Roentgenology 181, no. 5 (2003): 1309 - 1314.