Outcome of Laparoscopic Management of Undisturbed Ectopic Pregnancy Versus Medical Management

Background: Ectopic pregnancy (EP) is major health problem that women experience during reproductive years. The most frequent type of EP is tubal pregnancy, while non-tubal and heterotopic extra-uterine pregnancies are rare. Recently; ectopic pregnancy can be diagnosed before patient's clinical state is worsened.

Aim: was to compare outcome of laparoscopic therapy of undisturbed adenexial ectopic pregnancy versus medical therapy by methotrexate.

Methods: This randomized controlled clinical study on 50 patients attending outpatient clinic and inpatient at Department of Obstetrics and Gynecology -Tanta University Hospital. The study participants included women who underwent laparoscopy or underwent medical therapy with MTX for undisturbed adenexial ectopic pregnancy. We analyzed data of 50 women 25treated with single dose MTX and 25 cases treated with laparoscopy for undisturbed adenexial ectopic pregnancy between 2020and 2021. Success of treatment in laparoscopy group was defined as significant decrease in one week post-therapeutic quantitative β- HCG, while in MTX group success of treatment was defined as decrease in BHCG level more than15% between day 4 and day 7, with no need for surgical intervention..

Results: Success of treatment in laparoscopy group (23cases, 92%) and (18 cases, 72%) in methotrexate group, no statistically significant difference between two groups (p=0.306). In methotrexate group the 7 cases who had failed medical therapy, underwent laparoscopy. There was no statistically significant difference between the two groups regarding persistent trophoblast (p=0.490), as two (8%) cases in laparoscopy group, while no cases in methotrexate group.

Conclusions: Laparoscopic surgery is as effective as methotrexate therapy for conservative therapy of undisturbed adenexial ectopic pregnancy and methotrexate has advantage of being non-invasive procedure.