Nonsurgical management of tubal pregnancy. Necessity in view of the changing clinical appearance.

The incidence of ectopic pregnancy is definitely increasing. Ectopic pregnancies are diagnosed earlier these days because of the improvement in diagnostic means and the increasing awareness of the condition. It seems that there is a dramatic change in the clinical presentation of this disease; it used to be a grave and life-threatening condition, and now it is a more benign presentation. The vast majority of the diagnosed ectopic pregnancies are unruptured. This has stimulated various investigators to attempt nonsurgical methods of treatment such as systemic administration of methotrexate or RU 486 (mifepristone) or local injection of methotrexate, potassium chloride, or prostaglandins under laparoscopic or ultrasonographic guidance. Most of these conservative, nonsurgical measures proved efficient in 80% to 90% of cases. Expectant management, which was practiced in some cases, proved to be equally successful. We believe that the ideal mode of treatment in early unruptured ectopic pregnancy is still to be determined. The answer probably lies in proper selection.