Introduction

It is thought that up to a quarter of all ectopic pregnancies may be suitable for non-surgical management. Medical treatment of an ectopic pregnancy with systemic (e.g. methotrexate, actinomycin D) or local administration of drugs (e.g. potassium chloride, methotrexate, mifepristone or prostaglandin E2 and F2 alpha) into the gestation sac, has recently been introduced into clinical practice. Unlike surgical treatment, the conceptus is left in the fallopian tube to be spontaneously absorbed. This chapter will describe the indications and complications of this novel therapeutic approach.

Indications: choice of patients

8.2.1 NON-TUBAL PREGNANCY

The initial report (Tanaka et al., 1982) described the successful use of methotrexate in the treatment of a case of interstitial ectopic pregnancy. The choice of the anti-metabolite methotrexate (which inhibits dihydrofolate reductase and hence stops trophoblastic cell growth), as a first line chemotherapeutic agent is a logical one, in view of extensive experience in its use in the treatment of gestational trophoblastic disease. The addition of folinic acid acts as a rescue to the methotrexate, increasing the effectiveness and safety of the treatment. Three years after the initial report of treatment of a non-tubal ectopic pregnancy with methotrexate, Chotiner (1985) described the successful medical treatment of a tubal pregnancy associated with the severe hyperstimulation syndrome following ovulation induction with menopausal gonadotrophin.