1. Ectopic Pregnancy studies

2. Welcome

3. Introduction ESEP study inclusionESEP study inclusion Follow upFollow up FutureFuture Other projects: METEX studyOther projects: METEX study

4. www.cemach.org.uk

5. MMR EP 0.5/100,000 (1985-2005) “Despite effort, MMR for EP remains static last 20 yrs”

6. Alert CEMACH recommendation: Guidelines are urgently required for the management “Pain and bleeding in early pregnancy”CEMACH recommendation: Guidelines are urgently required for the management “Pain and bleeding in early pregnancy”. June 28th 2010 Invited session 9: Prevention of maternal death in early pregnancy J. Neilson (UK)

7. EP 1980-2005 Ref: data LMR - Prismant 2005: 1.500 women had surgery for EP 20% laparotomy only 25 % salpingotomy

8. Fertility

9. ESEP study n=450 PTubal EP, normale contra lateral tube ISalpingostomy CSalpingectomy OFertility (time to IUP), repeat EP, PT

10. ESEP study group

11. Inclusion, n=299 149 75 62 11

12. May – June 2009

13. ECTOPIC THINK ESEP INCLUDE INFORMED CONSENT FINISHED!!! N=450

14. Your hurdles? ? ? ? http://www.youtube.com/watch?v=_rmVkIZnX3U

15. Follow up Serum hCG follow up in both groups until undetectableSerum hCG follow up in both groups until undetectable Questionnaires every 6 monthsQuestionnaires every 6 months –Contraceptive use –Desire for pregnancy –Pregnancy outcome Data base online (www.esepstudy.nl)Data base online (www.esepstudy.nl)www.esepstudy.nl

16. Dialogue Future esep trialFuture esep trial ESEP

17. Ref: data LMR - Prismant EP 1980-2005

18. * 15% verschil IUP, Power 80% alpha 5%, LFU 10%: NNR 450 450-299= 151 1500 EPs per year 151/1500= 5.2 weeks ESEP inclusion completed!!

20. METEX study n= 72 Ongoing RCT for women with persisting PUL and serum hCG < 2,000 IU/l or women with an EP and serum hCG < 1,500 IU/l Expectant management vs single dose MTX Outcomes:uneventful decline serum hCG (>15%) quality of life, costs, fertility www.studies-obsgyn.nl www.metexstudy.nl

21. Inclusions: 32!

22. Study information Interested in participation? Eligible patient? www.studies-obsgyn.nlwww.metexstudy.nlmetex@amc.nl