Diagnosis and treatment of ectopic pregnancy

The combined use of transvaginal ultrasound and serial quantitative determination of the serum human chorionic gonadotropin (HCG) concentration offers an early and exact diagnosis of an ectopic pregnancy before the onset of clinical symptoms. Therefore, a large variety of invasive and noninvasive treatment options can be chosen. In patients without severe clinical symptoms, the trophoblast activity should be determined via the HCG course before invasive treatment methods are performed, because a considerable proportion part of the patients show spontaneous resolution of the ectopic pregnancy without further measures. Recently systemic treatment with methotrexate alone or local injection of different substances like prostaglandins, glucose, and methotrexate, etc. became an alternative to surgical therapy, i.e., endoscopic salpingotomy or salpingectomy. The success rates are generally lower in comparison to surgical therapy. Therefore, medical treatment is useful only in patients with a low trophoblast activity (e.g., <2,500 mIU/ml HCG). However, in cases with low HCG values, observation alone frequently leads to a resolution. Corresponding to the data being available up to now, the postoperative pregnancy rate does not depend on this decision.