Abstract

Background: Tubal pregnancy if diagnosed early, and unruptured, can be managed by a number of therapeutic modalities, like conservative surgery by operative laparoscopy, by medical management, by laparotomy, and occasionally by observation alone. Management must be tailored to the clinical condition and future fertility requirements of the woman. Aim of study: To show in properly selected cases, medical management of ectopic pregnancy is appealing for several advantages like less tubal damage, less cost, avoiding surgical risk, and enhanced potential for future fertility. Material and methods: Retrospective study was conducted on all cases of ectopic pregnancies admitted and managed in OBG department, in an undergraduate teaching hospital in North Karnataka. This study was conducted to review four cases, treated with single dose methotrexate as medical management for unruptured ectopic pregnancy during the period from 2011 to 2014. Successful completion of medical therapy is defined as a documented serum β-human chorionic gonadotropin of less than 5 miu/ml or a negative urine pregnancy test. Results. Out of all 26 cases of ectopic pregnancies treated in RIMS hospital, between 2011 to 2014 majority of cases i.e 22 cases were managed by surgical treatment, and four cases were selected for medical management, as per the medical management guidelines. Out of 4 cases two were successfully managed by a single dose metrotrexate, and one case was submitted for laparotomy, as HCG levels are not falling satisfactorily with single dose and patient also insists surgical management with concurrent tubectomy and for the other one second dose of methotrexate was given on 4th day. All four had uneventful recovery, and discharged on 7th day. Two of them had bilateral patent tubes, as shown by HSG, taken six months later. Two of them conceived six to ten months after HSG. Conclusion: There are multiple options available for management ectopic pregnancy depends on the hemodynamic stability of the patient. In properly selected patients medical management still holds good. Medical treatment should be preferred if the patient has undergone surgery many times previously, has extensive pelvic adhesions, a contraindication for general anesthesia, a cornual pregnancy, and after failure of a conservative laparoscopic treatment. Medical treatment is possible: if serum beta is-HCG is below10,000 mUI/mL, if the ectopic pregnancy size is less than 4 cm in diameter, or if the score is adequate. Medical treatment should be the preferred treatment if serum beta-hCG <1000 mUI/mL, if the patient has no pain and if the ectopic pregnancy cannot be visualized at ultrasound.>