LAPAROSCOPIC PROSTAGLANDIN INJECTION IN ECTOPIC PREGNANCY - SUCCESS RATES ACCORDING TO ENDOCRINE ACTIVITY

Objective: To investigate the clinical performance of local prostaglandin treatment of ectopic pregnancies (EPs) in relation to their biologic activity as determined by preoperative serum hCG levels. Design: Prospective study over a a-year period of 108 patients with 127 tubal pregnancies. Setting: A department of obstetrics and gynecology in a central county hospital. Patients: One hundred eight patients who presented with a clinical diagnosis of EP. Interventions: Patients with EP were treated with laparoscopy-guided injection of prostaglandin F-2 alpha in the surrounding tubal wall and the corpus luteum-bearing ovary. All members of the staff participated. Main Outcome Measures: Success rate, hospitalization cost, and convalescence period. Results: Seven laparotomies (7.5%) were performed postoperatively due to increasing hCG levels or ruptures with circulatory reactions. All except one had an initial (preoperative) hCG value > 1,000 mIU/mL (conversion factor to SI unit, 1.00). The mean hospitalization period was 2.7 days and 90% of the medically treated patients returned home on the first postoperative day. The mean convalescence period was 18 days. Conclusion: The procedure is simple and carries an acceptable success rate in cases with hCG levels < 1,000 mIU/mL. The approach demands minimal technical resources and it may reduce health care costs substantially.