Therapeutic target
- Termination of extrauterine pregnancy.
Therapy recommendations
The form of therapy remains a case-by-case decision and depends on the clinical situation:
- Wait-and-see – hoping for resorption (“self-digestion”),
- Drug (systemic: methotrexate or local: methotrexate, prostaglandin prostaglandin E2, F2a, glucose 50%, potassium chloride 20%), or
- Operative (pelviscopic/abdominal scavenging, by laparotomy/abdominal incision, or in the case of cervical gravidity (pregnancy in the cervix) by curettage/scraping)Note: In case of hemodynamic instability (acute abdomen, circulatory instability, acute signs of rupture (“bursting of the fallopian tube”) or peritoneal hemorrhage), immediate surgical intervention is required.
The exception at present seems to be cervical pregnancy (pregnancy in the cervix). Recent studies suggest that, because of the risk of extreme bleeding, drug therapy should be sought before surgery by curettage to denature the gravidity.
Indications:
- In asymptomatic patients (without symptoms) with falling hCG (control after 48 h > 15% fall), a wait-and-see attitude can be adopted, since spontaneous resorption often occurs in this constellation (hCG < 2,000 IU/l → 60%; hCG < 1,000 IU/l → 88%).
