Clinical treatment of ectopic pregnancy/Tratamento clinico da prenhez ectopica/ Conociendo el funcionamiento del laberinto

The early diagnosis of ectopic pregnancy has allowed for the adoption of a conservative management for patients with this condition. Thus, drug treatments and conservative managements of ectopic pregnancy are a growing trend, using methotrexate in single or multiple, systemic or local doses, it's also an option in the management of atypical ectopic pregnancy. So, the goal of this study is reviewing the conservative and drug management of ectopic pregnancy in order to establish the best selection and approach for this situation. The selection of patients for this approach follows some criteria: beta-hCG below 5000mUI/ml, adnexial mass below 3,5 cm, negative embryonic heart beats, beta-hCG titles rising over 48 hours, unrupted pregnancy, and adherence to follow up. The most used protocol is a single dose, with 50mg/[m.sup.2], simpler and with less collateral effects. The protocol of multiple doses is reserved for cases with higher titles of beta-hCG and pregnancies of atypical location, both with dead embryo. The use of local methotrexate, guided by ultrasonography, is done in situations with a live embryo. The conservative approach is reserved to patients with beta-hCG titles below 1500mUI/ml and decreasing values of beta-hCG. This way we can offer a new option of treatment, an alternative to a surgical procedure in those with contraindications or who desire to avoid it, with good results in the preservation of the reproductive future. It is also another option in places where laparoscopic surgery is not available, a frequent situation in the Brazilian public health system. Moreover, in the cases of pregnancy of atypical location, it is a safer approach in face of the surgical options for this condition, often mutilating and prone to complications.