Treatment of ectopic pregnancy with methotrexate

In the past the treatment of ectopic pregnancy was always surgical. With the advent of new diagnostic techniques and therapeutic procedures, their behavior has changed a lot and it has favored the conservation of the tubes. We can consider 2 main groups: medical and surgical treatment.Treatment of ectopic pregnancy with methotrexate: In Japan, in 1982 the first treatments were performed, which was recommended by the parallel use of this substance interstitial pregnancy. From these initial submissions have been numerous publications describing successful treatments for ectopic pregnancy with the use of different regimens of methotrexate. The action of methotrexate (a folic acid analogue) is to inhibit an enzyme (dehidrofolato reductase) and therefore prevents the synthesis of deoxyribonucleic acid (DNA) in the embryo.
Adverse effects: often reported leukopenia, thrombocytopenia, bone marrow aplasia, ulcerative stomatitis, diarrhea, hemorrhagic enteritis. Other effects have also been reported: alopecia, dermatitis, elevated liver enzymes and low-dose neumonitispero as used in the ectopic not described in the literature these effects. With regard to reproductive function has been reported that tubal patency is 71% after treatment. After treatment of ectopic pregnancy with methotrexate can be the following results:
Spontaneous resolution: some ectopic resolved by resorption or tubal abortion, eliminating the need for medical or surgical treatment. Ectopic site limited to the fallopian tube. No evidence of intraabdominal bleeding or tubal rupture on transvaginal ultrasound. Ectopic diameter greater than 3.5 cm.
Persistent ectopic pregnancy: when the patient has undergone conservative treatment and remains viable trophoblastic tissue. From the point of no embryo histologically identifiable residual chorionic villi are often confined to the muscle layer, the implantation of trophoblastic tissue in the peritoneum may be the cause of persistence.
Chronic ectopic pregnancy: is the condition in which pregnancy is not completely resorbed during watchful waiting: There is persistence of the chorionic villi with hemorrhage into the tubal wall is stretched slowly and break. This disorder is treated surgically.
Treatment of ectopic pregnancy by surgery:

Exploratory laparotomy is used for treatment of ectopic pregnancy from 1884.El surgical treatment is the most frequently used in ectopic pregnancy. With the advent of minimal access laparoscopic surgery, new strategies have been included in the surgery of ectopic pregnancy. It is necessary to consider many factors when evaluating the success or failure of an attempt pregnancy after treatment of ectopic pregnancy. These factors include age, previous births, bilateral tubal disease and previous rupture the fallopian tube. With the use of diagnostic techniques and innovative surgical procedures to preserve the damaged tubes have hoped to achieve subsequent pregnancies.

Sparing: Salpingostomy, also called linear salpingostomy. Used to remove a small pregnancy less than 2 cm long (not hard) and the distal third of the tube.
Radical techniques: salpingectomy: it can also be performed by laparoscopy, with ectopic rupture and without breakage.