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Noninvasive diagnosis of ectopic pregnancy should be performed early, before tubal rupture occurs, combining transvaginal ultrasound with measurement of the beta fraction of the chorionic gonadotropic hormone. Several treatment options can be used. We must respect the indications for both surgical interventions and clinical treatment. Laparotomy is indicated in cases of hemodynamic instability. Laparoscopy is the preferred route for treatment of tubal pregnancy. Salpingectomy should be performed in patients with established offspring. Salpingostomy is indicated in patients with reproductive desire, when b-hCG titers are less than 5,000 mIU/mL and surgical conditions are favorable. Treatment with methotrexate (MTX) is an established procedure and may be indicated as the first treatment option. The main criteria for indicating MTX are hemodynamic stability, b-hCG <5,000 mIU/mL, adnexal mass <3.5 cm and absence of a live embryo. The single intramuscular dose of 50 mg/m² is preferred because it is easier, more practical and has fewer side effects. The protocol with multiple doses should be restricted to cases of atypical location (interstitial, cervical, cesarean scar and ovarian) with b-hCG values >5,000 mIU/mL and absence of a live embryo. The indication for local treatment with MTX injection (1 mg/kg) guided by transvaginal ultrasound is in the presence of a live embryo in cases of atypical location. Expectant management should be indicated in cases of declining b-hCG titers in the 48 hours before treatment and when initial titers are less than 1,500 mIU/mL. Regarding future reproductive health, there is controversy between salpingectomy and salpingostomy. Until we reach a consensus in the literature, we advise patients desiring a future pregnancy to opt for conservative approaches, both surgical and clinical.
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Copyright (c) 2025 Kerolaine Silva Fonseca, Anna Luíza Barbosa da Silva Almeida, Raul Sescato Rezende Pinto, Lucas Moura Araujo Luz, Tayná de Paiva Marques Carvalho, Marcus Vinícius de Magalhães Oliveira, Jan Carlos Leão Alves, Paulo Cesar Mouchalouat Filho, Pedro Repani Marcatti, Priscila Leite Loiola Ribeiro, Raphael Alves Gomes Braga, Isabella Fróes Demétrio, Camila Kelly de Melo Fidelis, Eliane Teixeira dos Santos, Thalia Ely Cervejeira, Bruna Alacoque Amorim Lima, Mariana Rodrigues Bezerra, Anne Caroline Tavares de Carvalho