Medical Treatment of Undisturbed Ectopic Pregnancy in Minia Maternity University Hospital a Randomized Controlled Study

Background: Ectopic pregnancy, a high-risk condition in which a fertilized ovum implants outside 
the uterine cavity, affects 1% to 2% of all pregnancies and poses a significant threat to women of 
reproductive age. It is the leading cause of maternal death during the first trimester of pregnancy and 
is responsible for 9% of pregnancy-related deaths in the United States (Creanga et al., 2011).
Clinicians should consider the diagnosis of ectopic pregnancy in any woman in the first trimester of 
pregnancy that has abdominal or pelvic pain, vaginal bleeding or both (ACOG, 2009). After a 
definitive diagnosis has been made, treatment options include medical, surgical, or expectant 
management (Hajenius et al., 2007). Aim of the work: The aim of our study was to evaluate the 
efficacy and safety of medical treatment of undisturbed ectopic pregnancy either by Methotrexate, or 
by Aromatase inhibitors "Letrozole" in comparison to laparoscopic treatment for the same purpose in 
well selected cases of undisturbed ectopic pregnancy at Minia Maternity University Hospital during 
period from January 2018 to December 2018. Patients and Methods: 400 candidates for the study 
were diagnosed with ectopic pregnancy either through the outpatient clinics or admitted through the 
emergency department. These candidates were subjected to full work up. Following this workup, only 
200 candidates were diagnosed with undisturbed ectopic pregnancy. From these 200 cases of 
undisturbed ectopic pregnancy 34 cases of them were eligible to be in our study according our strict 
inclusion criteria: These 34 cases which fulfilled our inclusion criteria were randomized by closed 
sealed envelopes into 3 groups: Group Ι (Laparoscopy group) It included 10 patients, who had 
laparoscopic salpingostomy as a first line of treatment for undisturbed ectopic pregnancy. Group ΙΙ 
(Methotrexate group): It included 10 patients, who had given a single dose of Methotrexate (1 mg/kg 
IM in a single injection) as a first line of treatment for undisturbed ectopic. Group ΙΙΙ (Letrozole 
group): It included 14 patients, who had given Letrozole 2.5mg, in combination with Norethisterone 5 
mg as an adjuvant therapy for 10 days both twice daily as a first line of treatment for undisturbed 
ectopic. Results: The Success rate of the first line of treatment in each group and it was in 
laparoscopy group (90%), methotrexate group was (80%) and in Letrozole group was (78.6%), 
therefore the Letrozole can be used in the treatment of undisturbed ectopic in well selected cases.
Conclusion: Laparoscopy remains the gold standard first line modality for diagnosis and treatment of 
undisturbed ectopic pregnancy. It is also the modality of choice in case of failure of medical 
treatment. Medical treatment with methotrexate for undisturbed ectopic pregnancy has its definite role 
as an alternative to laparoscopy. Letrozole has the advantage of easy administration and high safety 
profile when compared to methotrexate and laparoscopy