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Contemporary Management of Ectopic Pregnancies

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Practical Manual of Operative Laparoscopy and Hysteroscopy

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Abstract

The incidence of ectopic pregnancies has increased fourfold since 1970. (1) Ectopic pregnancy now accounts for roughly 1.2% to 1.4% of reported pregnancies.(2) This may be the consequence of our ability to treat pelvic inflammatory disease (PID) effectively before permanent tubal obstruction occurs or it may be a reflection of the general trend toward delayed childbearing. Early diagnosis and treatment have reduced mortality and morbidity, as well as probably improving subsequent fertility. Advances in ultrasound, particularly transvaginal imaging, and human chorionic gonadotropin (ß-hCG) detection have considerably improved our diagnostic capability. Laparoscopy is an integral part of the diagnostic scheme and recently has become the preferred therapeutic method when surgery is required. Depending on the patient’s desire for future fertility and the extent of her disease, conserva-tive as well as radical surgery may be performed laparoscopically.

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References

  1. Centers for Disease Control. Ectopic pregnancy: United States, 1987. MMWR 1990;39: 2425.

    Google Scholar 

  2. Coste J, Job-Spira N, Aublet-Cuvlier B, et al. Incidence of ectopic pregnancy; first results of a population-based register in France. Human Re-prod (Oxf). 1994;9:742–745.

    CAS  Google Scholar 

  3. Norman RJ, Buck RH, Rom L, Joubert S. Blood and urine measurement of human chorionic gonadotropin for detection of ectopic pregnancy? A comparative study of quantitative methods in both fluids. Obstet Gynecol. 1988; 71:315–318.

    PubMed  CAS  Google Scholar 

  4. Romero R, Kadar N, Copel JA, Jeanty P, De Cherney AII, Hobbins JC. The effect of different human chorionic gonadotropin assay sensitivity on screening for ectopic pregnancy. AmJ Obstet Gynecol. 1985;153:72–78.

    CAS  Google Scholar 

  5. Fossum GT, Davajan V, Kletzky OA. Early detection of pregnancy with transvaginal ultrasound. Fertil Steril. 1988;49:788–790.

    PubMed  CAS  Google Scholar 

  6. Bateman BG, Nunley WC Jr, Kolp LA, Kitchen JD III, Felder R. Vaginal sonography findings and hCG dynamics of early intrauterine and tubal pregnancies. Obstet Gynecol. 1990;75: 421–426.

    PubMed  CAS  Google Scholar 

  7. Bree RL, Edwards M, Bohm-Velez M, Beyler S, Roberts J, Mendelson EB. Transvaginal sonography in the evaluation of normal early pregnancy: correlation with hCG level. AmJRadiol. 1989;153:75–82.

    CAS  Google Scholar 

  8. Reich H, Johns DA, DeCaprio J, McGlynn F, Reich F. Laparoscopie treatment of 109 consecutive ectopic pregnancies. J Reprod Med. 1988; 33:885–889.

    Google Scholar 

  9. Nager CW, Murphy AA. Ectopic pregnancy. Clin Obstet Gynecol. 1991;34:403–411.

    Article  PubMed  CAS  Google Scholar 

  10. Murphy AA. Diagnostic and operative laparoscopy. In: Thompson JD, Rock JA, eds. TeLinde’s Operative Gynecology. 7th ed. Philadelphia: Williams & Wilkins; 1991:361–384.

    Google Scholar 

  11. Sherman D, Langer R, Sadovsky G, et al. Improved fertility following ectopic pregnancy. Fertil Steril. 1982;37:497–502.

    PubMed  CAS  Google Scholar 

  12. Tulandi T, Guralnick M. Treatment of tubal ectopic pregnancy by salpingotomy with or without tubal suturing and salpingectomy. Fertil Steril. 1991;51:53–58.

    Google Scholar 

  13. Pauerstein CJ, Croxatto HB, Eddy CA, Ramay I, Walters MD. Anatomy and pathology of tubal pregnancy. Obstet Gynecol. 1986;67:301–308.

    PubMed  CAS  Google Scholar 

  14. Mecke H, Semm K, Lehmann-Weillenbrock E. Results of operative pelviscopy in 202 cases of ectopic pregnancy. IntJFertil. 1989;34:93–100.

    CAS  Google Scholar 

  15. Henderson SR. Ectopic tubal pregnancy treated by operative laparoscopy. Am J Obstet Gynecol. 1989;160:1462–1464.

    PubMed  CAS  Google Scholar 

  16. Stovall TG, Ling FW, Gray LA, Carson SA, Buster JE. Methotrexate treatment of unruptured ectopic pregnancy: a report of 100 cases. Obstet Gynecol. 1991;77:749–753.

    PubMed  CAS  Google Scholar 

  17. Stovall TG, Ling FW, Gray LA. Single dose methotrexate for treatment of ectopic pregnancy. Obstet Gynecol. 1991;77:754–757.

    PubMed  CAS  Google Scholar 

  18. Horne LA, Younger JB. Low-dose oral methotrexate therapy of presumed ectopic pregnancy. 45th Annual Meeting of the American Fertility Society, 1989, San Francisco, CA. Abstract #0–02.

    Google Scholar 

  19. Buster JE, Carson SA. Ectopic pregnancy: new advances in diagnosis and treatment. Curr Opin Obstet Gynecol. 1995;7:168–176.

    Article  PubMed  CAS  Google Scholar 

  20. Wolf GC, Witt BR. Outpatient laparoscopie management of ectopic pregnancy with local methotrexate injection. J Reprod Med. 1991; 36:489–491.

    PubMed  CAS  Google Scholar 

  21. Tulandi T, Atri M, Bret P, Falcone T, Khalife S. Transvaginal intratubal methotrexate treatment of ectopie pregnancy. Fertil Steril. 1992; 58:98–100.

    PubMed  CAS  Google Scholar 

  22. Stovall TG, Ling FW. Single-dose methotrexate as expanded clinical trial. Am J Obstet Gynecol. 1993;168:1759–1772.

    PubMed  CAS  Google Scholar 

  23. Glock JL, Johnson JV, Brumsted JR. Efficacy and safety of single-dose systemic methotrexate in the treatment of ectopie pregnancy. Fertil Steril. 1994;62:716–721.

    PubMed  CAS  Google Scholar 

  24. Stovall TG, Ling FW. Ectopic pregnancy diagnostic and therapeutic algorithms minimizing surgical intervention. J Reprod Med. 1993; 38:807–812.

    PubMed  CAS  Google Scholar 

  25. Crenin MD, Washington AE. Cost of ectopic pregnancy management: surgery versus methotrexate. Fertil Steril. 1993;60:963–968.

    Google Scholar 

  26. Seifer DB, Silva PD, Grainger DA, Barber SR, Grant WD, Gutmann JN. Reproductive potential after treatment for persistent ectopic pregnancy. Fertil Steril. 1994;62:194–196.

    PubMed  CAS  Google Scholar 

  27. Shapiro HI, Adler DH. Excision of an ectopic pregnancy through the laparoscope. AmJObstet Gynecol. 1973;117:290–293.

    CAS  Google Scholar 

  28. Pouly MA, Mahnes H, Mage G, Canis M, Bruhat MA. Conservative laparoscopie treatment of 321 ectopie pregnancies. Fertil Steril. 1988;46: 1093–1097.

    Google Scholar 

  29. DiMarchi JM, Kosasa TS, Kobara TY, Hale RW. Persistent ectopic pregnancy. Obstet Gynecol. 1987;70:555–561.

    PubMed  CAS  Google Scholar 

  30. Brumsted J, Kessler C, Gibson M. A comparison of laparoscopy and laparotomy for the treatment of ectopie pregnancy. Obstet Gynecol. 1988; 71:889–893.

    PubMed  CAS  Google Scholar 

  31. Vermesh M, Silva PD, Rosen GF, Stein AL, Fos-sum GT, Sauer MV. Management of unruptured ectopic gestation by linear salpingostomy: a prospective randomized clinical trial of laparoscopy vs. laparotomy. Obstet Gynecol. 1989; 73:400–408.

    PubMed  CAS  Google Scholar 

  32. Murphy AA, Nager CW, Wujek JJ, Kettel LM, Chin HG. Operative laparoscopy vs. laparotomy in the management of ectopie pregnancy: a prospective trial. Fertil Steril. 1992;57: 1180–1185.

    PubMed  CAS  Google Scholar 

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Authors
  1. Ana Alvarez Murphy
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  2. Sujatha Reddy
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Editor information

Editors and Affiliations

  1. Department of Obstetrics and Gynecology, University of Alabama School of Medicine, 618 South 20th St., Birmingham, AL, 35233-7333, USA

    Ricardo Azziz M.D., M.P.H. (Professor) (Professor)

  2. Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Emory University School of Medicine, 1639 Pierce Drive, Atlanta, GA, 30322, USA

    Ana Alvarez Murphy M.D. (Director) (Director)

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© 1997 Springer Science+Business Media New York

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Murphy, A.A., Reddy, S. (1997). Contemporary Management of Ectopic Pregnancies. In: Azziz, R., Murphy, A.A. (eds) Practical Manual of Operative Laparoscopy and Hysteroscopy. Springer, New York, NY. https://doi.org/10.1007/978-1-4612-1886-9_12

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  • DOI: https://doi.org/10.1007/978-1-4612-1886-9_12

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4612-7324-0

  • Online ISBN: 978-1-4612-1886-9

  • eBook Packages: Springer Book Archive

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