What decision should be taken for the embryo in a tubal pregnancy?

Abstract

The rising of ectopic pregnancy is more likely to occur in women who have suffered pelvic infections, endometriosis and tubal damage through tubal sterilization and its reversal. There is also an increased incidence in infertile women, many of whom have undergone tubai investigations and assisted conception procedures. lndeed, the use of recent "contraceptives", which are more likely abortifacient, plays also a significant role. Thc article deals with the ethical values involved in the different decisions that could be taken in treatment of this pathological situation: a) to wait for the spontaneous reabsorption or to intervene with a salpingectomy, especially when there is a real danger for the mother's life (for an impending intraperitoneal bleeding); b) to inject either prostaglandins or methotrexate into gestational sac in order to interrupt the embryo's life and pregnancy becomes absorbed; c) to "remove" thc ectopic embryo by salpingotomy. AlI these three decisions involve destruction of the ectopic gestation with no prospcct of a continuing pregnancy so that they are ethically questionable. d) A recently described successful intervention of intrauterine relocation of an ectopic pregnancy is the occasion to rethink what is better for a such condemned embryo. In the authors' view this new possibility seems to bave a really therapeutic perspective, so that it must be studied thoroughly, given also the availability of improved, powerful diagnostic tools for early diagnosis of ectopic pregnancy. Moreover, it is necessary to educate women to undergo early diagnosis as well as to participate in the evaluation of a suitable surgical technique, and more generally, to prevent risk factors of ectopic pregnancy.