The fertility sparing therapy of ectopic pregnancy.

Abstract

Objective: A review of current knowledge on the possibilities of fertility sparing therapy in case of ectopic pregnancy.

Design: Review article.

Methods and results:  Ectopic pregnancy is defined as the implantation of an embryo outside the endometrial cavity , most often in the fallopian tube. This diagnosis is a very common among young women. Ectopic pregnancies can be treated using the following three approaches, which can be combined: expectantly, pharmacologically, or surgically.

Fertility-sparing salpingostomy may be performed during surgical treatment. Medical (pharmacological) treatment consists of methotrexate with a success rate of 75% to 96% depending on the initial blood ꞵ-hCG level. This is a safe treatment with minimal side effects.

There is no standardization of the blood β-hCG level limits or of the size of the ectopic pregnancy mass in the selection of the patients to be selected for expect, surgical, or medical treatment. The considerable rise in the rate of Cesarean section over the last decades has led to an increase in the occurrence of the implantation of the gestational sac in the hysterotomy scar. There are several ways to address this diagnosis, but none is clearly preferred. This issue is also discussed in the article.

Conclusion:  The goal of ectopic pregnancy treatment is to choose a safe and effective therapy with a low incidence of side effects and maintaining the maximum fertility of women. Properly set indication criteria are most important when choosing the right option.