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.