Have we overlooked the role of mifepristone for the medical management of tubal ectopic pregnancy?

Ectopic pregnancy is a risk of both spontaneous and assisted reproduction pregnancies. The majority of ectopic pregnancies abnormally implant within a fallopian tube (extrauterine pregnancies). In haemodynamically stable women, medical or expectant treatment can be offered. Currently accepted medical treatment is using a drug called methotrexate. However, methotrexate has potential adverse effects, and a significant proportion of women will still require emergency surgery (up to 30%) to remove the ectopic pregnancy. Mifepristone (RU-486) has anti-progesterone effects and has a role in managing intrauterine pregnancy loss and termination of pregnancy. On reviewing the literature and given progesterone's pivotal role in sustaining pregnancy, we propose that we may have overlooked the role of mifepristone in the medical management of tubal ectopic pregnancy in haemodynamically stable women.

Automated summary

Ectopic pregnancy can occur in both natural and assisted reproduction pregnancies, predominantly within the fallopian tube. Medical or expectant treatment may be offered to haemodynamically stable women. Methotrexate is currently the accepted medical treatment, although it has potential adverse effects and a significant proportion of women still require emergency surgery for removal of the ectopic pregnancy. Mifepristone, with its anti-progesterone effects, has a potential role in managing tubal ectopic pregnancy in haemodynamically stable women, given the pivotal role of progesterone in sustaining pregnancy, which may have been overlooked.