A cohort study to evaluate the effectiveness of laparoscopic-guided local injection of etoposide in the management of women with unruptured tubal pregnancy.

OBJECTIVE

To assess the feasibility of laparoscopic-guided local injection of etoposide or methotrexate (MTX) in the management of unruptured tubal pregnancy and compare the effectiveness of the two regimens.

DESIGN

Retrospective cohort study.

SETTING

Medical center.

PATIENT(S): Thirty-one women with laparoscopically diagnosed unruptured tubal pregnancy.

INTERVENTION(S): A regimen of etoposide 50 mg via laparoscopic-guided local injection (n = 17) compared with a conventional MTX 50 mg regimen (n = 11), after 3 patients were excluded (2 refusals and 1 with salpingostomy).

MAIN OUTCOME MEASURE(S): Serial serum β-hCG levels and the success rate in both groups.

RESULT(S): General characteristics of the patients were similar in both groups. The overall success rate was 96.4% (27 of 28). The duration between treatment and nadir of serum β-hCG level (<5 mIU/mL) was significantly shorter in the etoposide group than in the MTX group (19.7 ± 13.0 days vs. 33.4 ± 8.1 days). No patient in the etoposide group and only 1 in the MTX group needed reintervention, which led to 100% and 91% success rates for the etoposide and MTX groups, respectively. Three women in the etoposide group had subsequently successful term deliveries.

CONCLUSION(S): Both regimens-etoposide 50 mg and MTX 50 mg via laparoscopic-guided local injection-were acceptable in the management of women with unruptured tubal pregnancy because of their similar and high success rates. More studies are needed to confirm this observation.