1. TREATMENT OPTIONS IN MANAGEMENT OF ECTOPIC PREGNANCY INTRODUCTION

2. It is pregnancy outside the uterine cavity,it could be in the fallopian tubes, ovaries, cervix, caesarean section scar or abdomen. Its incidence is : 2% but it is variable all over the world. It is due to anatomical or mechanical dysfunction of the fallopian tubes. 3

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5. RISK FACTORS 1-family history 2-old age 3-IVF 4-multiple sexual partner 5-PID 6-previous ectopic pregnancy 7-IUCD 8-previous surgery 9-endometeriosis 6

6. CLINICAL PRESENTION Ectopic pregnancy is called the decieving disease because of variability of clinical presentations, the patient could be: 1-asymptomatic discovered accidently by ultrasound. 2-variable symptomslike vaginal bleeding or abdominal pain or distension. 3-shock state. 7

7. DIAGNOSIS 1-clinical signs and symptoms. 2- investigations which include: *ultrasound :has fundemental role in the diagnosis *serum HCG(doubling time). *serum progesterone 8

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9. MANAGEMENT 1-SURGICAL MANAGEMENT: It include the followings: *salpingectomy; removal of fallopian tube. * salpingotomy ; opening of fallopian tube and removal of ectopic pregnancy. *salpingostomy; opening of fallopian tube and removal of ectopic pregnancy and leaving the tube margin open 10

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11. Salpingectomy indicated in: *severly damaged tube. *ruptured ectopic pregnancy. *recurrent ectopic pregnancy in the same tube. *when the other tube is healthy. 12

12. Salpingotomy or salpingostomy used in case: *mildly damaged tube. *intact ectopic pregnancy. *the other tube is not healthy. * the other tube has been removed previously. 13

13. 14 Laprotmoy,indications; *patient in shock. *doubtful diagnosis. *contrindication to laproscopy like morbid obesity or severe adhesions. *lack of facilities or experience in laproscopic procedures.

14. laproscopy:indications: *Patient is stable. *confirmed diagnosis. *presence of facilities or experience in laproscopic procedures. *no contraindications to laproscopy. 15

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16. 2-MEDICAL TREATMENT Methotrexate 50 mg given IM (the dose can be repeated), used in certain situation: *no fetal heart rate can be seen. *GA smaller than 4 cm. *haemodynamically stable. *no blood or free fluid in the peritoneal space. *able of follow up by HCG. *patient acceptance. 17

17. 3-CONSERVATIVETREATMENT: It involve watchful waiting with follow up by ultrasound and HCG used in limited cases and willingness of the patient is so important because of the associated risk of ectopic pregnancy rupture. The advantage of this option is the avoidance of any surgical or medical intervention but the success rate is similar among all management options. 18