Medical management of ectopic pregnancies

Ectopic pregnancy is still the number one cause of maternal even in the developed countries like USA. The incidence is around 20% of all pregnancies the incidence of ectopic pregnancy is on the rise (6 fold increase) due to the increase in sexually transmitted diseases, PID and ART procedures.
If we can diagnose ectopic pregnancy early by the routine use of TVS & color doppler we might be able to offer a medical option to these patients and save them from surgery.
The medical option of treatment of ectopic could be local injections of anti trophoblastic drugs or systemic injections. It has to be kept in mind that to offer medical option a strict preselection criteria must be observed specially a sac size of < 35 cm and a _ HCG of less than 10,000 units with systemic methotre-xate use as single injection or variable region the success role. In one study (n = 75 cases) was 90% as compared to Speroff 94 (95%) & Slaughter 95 (92%). A non-responsive rate and tubal rupture was seen in 3-4%. Only 3-10% pts. have shown side effects.Medical treatment is safe and very effective in property selected cases.
Today a Risk approach to all antenatal and intrapartum cases in strangly advisable.