Reasonable choice of treatment method for ectopic pregnancy

Ectopic pregnancy is currently the most common gynecological acute abdomen. Early diagnosis and treatment can reduce the risk of hemorrhagic shock, avoid excessive damage to the fallopian tubes, preserve reproductive function, and reduce complications. Choose the appropriate treatment method based on the patient's condition, whether or not they have fertility requirements, and other comprehensive considerations.

1. Non-surgical treatment

Non-surgical treatment includes expectant management and medical therapy.

Expectant therapy: A small number of tubal pregnancies may result in spontaneous abortion or absorption, with mild symptoms and no need for surgery or drug treatment. Expectant therapy is applicable to: ① Mild abdominal pain and little bleeding; ② No signs of tubal pregnancy rupture; ③ Blood β-HCG <1000U/L and continues to decrease; ④ Tubal pregnancy mass <3cm or not detected; ⑤ No intra-abdominal bleeding. During the expectant process, attention should be paid to changes in vital signs and abdominal pain, and B-ultrasound and blood β-HCG dynamic monitoring should be performed.

Drug treatment: It is mainly suitable for young patients with early tubal pregnancy, good general condition, and who want to preserve their fertility. This method can generally be used for those who meet the following conditions: ① No contraindications to drug treatment; ② No rupture or miscarriage of tubal pregnancy; ③ The diameter of the tubal pregnancy mass is ≤3cm; ④ Blood β-HCG <2000IU/L; ⑤ No obvious internal bleeding.

2. Surgical treatment

Surgical treatment can be divided into the following three types of procedures: ① Conservative surgery: suitable for young patients who want to have children. If the contralateral fallopian tube has been removed or has obvious lesions, conservative surgery to preserve the fallopian tube can be performed. ② Pregnancy salpingectomy: suitable for patients with tubal pregnancy rupture or internal bleeding complicated by shock or no fertility requirements. ③ Laparoscopic surgery.