Ectopic pregnancy: Expectant management
- Togas Tulandi, MD, MHCM
Togas Tulandi, MD, MHCM
- Professor of Obstetrics and Gynecology
- Milton Leong Chair in Reproductive Medicine
- McGill University, Canada
Ectopic pregnancy is a gynecologic emergency, generally requiring expeditious surgical or medical treatment. However, in a small number of cases in which the risk of tubal rupture is minimal, expectant management is appropriate. Women who are candidates for expectant management of ectopic pregnancy require informed consent about the risks of this strategy and close observation until the pregnancy has resolved.
In a historic study, expectant management versus surgery in women with ectopic pregnancy, regardless of risk factors for tubal rupture, resulted in a 57 percent success rate . However, most of the patients who failed this approach had significant complications (ie, tubal rupture) or ultimately required surgery for ongoing pregnancy.
Success rates of expectant management vary from 48 to 100 percent, depending in large part on differences in inclusion criteria .
Expectant management of ectopic pregnancy will be discussed here. Medical and surgical management of ectopic pregnancy are reviewed separately. (See "Ectopic pregnancy: Choosing a treatment and methotrexate therapy" and "Ectopic pregnancy: Surgical treatment" and "Abdominal pregnancy, cesarean scar pregnancy, and heterotopic pregnancy" and "Cervical pregnancy".)
CANDIDATES FOR EXPECTANT MANAGEMENT
Selection criteria — When ectopic pregnancy is suspected, in our practice, we employ expectant management only for patients who meet the following criteria: (1) transvaginal ultrasound (TVUS) does not show a gestational sac or demonstrate an extrauterine mass suspicious for an ectopic pregnancy and (2) the beta-human chorionic gonadotropin (hCG) concentration is low (≤200 mIU/mL) and declining . This also the threshold advised by the American College of Obstetricians and Gynecologists (ACOG) . We define a declining hCG level as lower at the third measurement than at the first measurement.
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