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Kenfack B, Nguefack-Tsague G, Ateudjeu J, Che GA, Mboudou ET. Fertility after ectopic pregnancy in a district hospital in Cameroon. Int J Gynaecol Obstet 2015; 130:165-8. [PMID: 25916965 DOI: 10.1016/j.ijgo.2015.02.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Revised: 01/20/2015] [Accepted: 04/08/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To assess spontaneous conception after an ectopic pregnancy (EP) in a rural area of a low-resource country. METHODS The present prospective cohort study enrolled patients aged 15-45 years who were treated for EP at Sangmelima District Hospital, Cameroon, between January 2006 and December 2008. All patients who wished to become pregnant in the future were included and followed up from treatment for EP either until termination of a subsequent pregnancy or for 3 years if they did not become pregnant, whichever came first. Patients who were followed up for less than 18 months without a pregnancy were excluded from analysis. RESULTS The final analysis included 56 women, of whom 23 (41%) became pregnant (21 [38%] had intrauterine pregnancies, 2 [4%] EPs). The mean interval between treatment for EP and first conception was 11.82±7.46 months. In multivariate analysis, absence of contralateral adnexal pathology was significantly associated with higher fertility (hazard ratio 9.00, 95% confidence interval 1.48-54.67; P=0.017). CONCLUSION Fertility after EP in a rural area of Cameroon was found to be low, but recurrence of EP was rare.
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Affiliation(s)
- Bruno Kenfack
- Department of Biomedical Sciences, Faculty of Sciences, University of Dschang, Dschang, Cameroon.
| | - Georges Nguefack-Tsague
- Public Health Department, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Jerôme Ateudjeu
- Department of Biomedical Sciences, Faculty of Sciences, University of Dschang, Dschang, Cameroon
| | - Gilbert A Che
- Ministry of Public Health, West Regional Delegation, Bafoussam, Cameroon
| | - Emile T Mboudou
- Department of Gynecology and Obstetrics, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
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Lesavre M, Curinier S, Capmas P, Rabischong B, Fernandez H. [Treatment of tubal ectopic pregnancy by methotrexate]. ACTA ACUST UNITED AC 2015; 44:212-9. [PMID: 25661494 DOI: 10.1016/j.jgyn.2014.12.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 12/02/2014] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To make a literature analyse about methotrexate as a treatment of tubal ectopic pregnancy. MATERIALS AND METHODS We made a PubMed research and found articles, randomized control studies, systematic revues and meta-analyses of the Cochrane Database about ectopic pregnancies treated by methotrexate. We made a summary of these articles. RESULTS Methotrexate can be used as a treatment of tubal ectopic pregnancy with hCG<5000 UI/L and expectative is an option if hCG level is lower than 1500 UI/L. Medical treatment by methotrexate seems to be less effective than surgical salpingotomy but the rate of recurrence and the rate of intra-uterine pregnancy are similar regardless of the treatment chosen. Fertility seems to be the same after treatment by methotrexate. Economically, methotrexate is less expensive than the surgical management (laparoscopy). CONCLUSION Methotrexate can be used as a treatment of tubal ectopic pregnancies if every criterions of safety are gathered.
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Affiliation(s)
- M Lesavre
- Service de gynécologie-obstétrique, CHU Bicêtre, 78, avenue du général-Leclerc, 94276 Le Kremlin-Bicêtre, France.
| | - S Curinier
- Service de gynécologie-obstétrique, CHU Estaing, 1, place Lucie-Aubrac, 63003 Clermont Ferrand, France
| | - P Capmas
- Service de gynécologie-obstétrique, CHU Bicêtre, 78, avenue du général-Leclerc, 94276 Le Kremlin-Bicêtre, France
| | - B Rabischong
- Service de gynécologie-obstétrique, CHU Estaing, 1, place Lucie-Aubrac, 63003 Clermont Ferrand, France
| | - H Fernandez
- Service de gynécologie-obstétrique, CHU Bicêtre, 78, avenue du général-Leclerc, 94276 Le Kremlin-Bicêtre, France
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Babu AS, Roy J, Das D, Banerjee D. Is surgical intervention for ectopic pregnancy in a low resource set-up avoidable? J Clin Diagn Res 2014; 8:OC16-9. [PMID: 25386488 DOI: 10.7860/jcdr/2014/8226.4815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Accepted: 07/10/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Ectopic pregnancy is one of the most common life threatening complications in the first trimester of pregnancy having significant adverse effects on future pregnancy outcome, particularly if salpingectomy is used as the modality of treatment. So medical management is now advocated. For that, cases need to be diagnosed at an earlier stage. Keeping these backgrounds in mind we took up this study to look into the feasibility of conservative management- both medical and surgical - in a tertiary care centre. AIMS To find out the demographic profile and risk factors of the ectopic pregnancy cases; the clinical presentation of the cases; the mode of treatment offered to the patients. MATERIALS AND METHODS It was a record based retrospective study.All the patients diagnosed as ectopic pregnancy in a tertiary care hospital from January, 2011 to December, 2012, was included in the study. RESULTS A total of 234 ectopic cases (1.5% of total deliveries) were recorded, constituting 5.4% of total gynaecological emergencies of this institute. Majority of patients were multigravida (74.4%) and of age group of 26-30years (35.9%). Fallopian tube was the most common site (99.1%) with only two cases in ovary. Ampulla (71.4%) was found to be most frequent site for implantation in fallopian tube. Pelvic inflammatory diseases (38.5%) and past history of induced abortion (35.9%) were major risk factors. Most patients (63.3%) did not use any contraceptives and 30.3% patients used OCP intermittently. No patient presented before 4weeks of gestation, while 69.2% presented between 4-7weeks and the rest beyond 7week. They presented with shock in 44.9% cases. Surgical treatment was offered in 98.3% cases, while medical treatment was offered to only four cases. CONCLUSION There is a huge surgical burden due to ectopic pregnancy impinging on our hospital resources. Surgery is resorted to indiscriminately for even those cases that could have been medically treated otherwise. Hence, the need to change the mindset of the care-providers at all levels to opt for medical management of ectopic pregnancy wherever applicable.
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Affiliation(s)
- Anindita Sinha Babu
- Assistant Professor, Department of Pathology, College of Medicine and Jawaharlal Nehru Memorial Hospital , WBUHS, Kalyani, Nadia, West Bengal, India
| | - Jayeeta Roy
- Assistant Professor, Department of Obstetrics and Gynaecology, College of Medicine and Jawaharlal Nehru Memorial Hospital , WBUHS, Kalyani, Nadia, West Bengal, India
| | - Dipanwita Das
- Assistant Professor, Department of Pathology, College of Medicine and Jawaharlal Nehru Memorial Hospital , WBUHS, Kalyani, Nadia, West Bengal, India
| | - Dipankar Banerjee
- Senior Resident, Department of Obstetrics and Gynaecology, College of Medicine and Jawaharlal Nehru Memorial Hospital , WBUHS, Kalyani, Nadia, West Bengal, India
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Ohannessian A, Loundou A, Courbiere B, Cravello L, Agostini A. Ovarian responsiveness in women receiving fertility treatment after methotrexate for ectopic pregnancy: a systematic review and meta-analysis. Hum Reprod 2014; 29:1949-56. [DOI: 10.1093/humrep/deu174] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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Abstract
We provide a review of microRNA (miRNA) related to human implantation which shows the potential diagnostic role of miRNAs in impaired endometrial receptivity, altered embryo development, implantation failure after assisted reproduction technology, and in ectopic pregnancy and pregnancies of unknown location. MicroRNAs may be emerging diagnostic markers and potential therapeutic tools for understanding implantation disorders. However, further research is needed before miRNAs can be used in clinical practice for identifying and treating implantation failure.
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Odejinmi F, Oliver R. Salpingotomy versus salpingectomy in women with tubal pregnancy. J Comp Eff Res 2014; 3:241-3. [PMID: 24969151 DOI: 10.2217/cer.14.12] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Evaluation of: Mol F, van Mello NM, Strandell A et al. Salpingotomy versus salpingectomy in women with tubal pregnancy (ESEP study): an open-label, multicentre, randomised controlled trial. Lancet 383(9927), 1483-1439 (2014). Ectopic pregnancy can still manifest itself as a life-threatening condition and, hence, the establishment of accurate evidence-based treatment modalities remain paramount. Surgical treatment has long been a mainstay of ectopic pregnancy treatment. To date, there is a wealth of data establishing laparoscopic treatment as the 'gold standard'; however, paradoxically, the evidence behind choosing the two main treatment methods of salpingotomy and salpingectomy, especially with regards to future fertility potential, remain unclear. This article is a summary of a randomized controlled trial of salpingotomy versus salpingectomy in patients with an apparent contralateral healthy tube and the impact on future fertility. It attempts to answer the clinical question whether preservation of tube by salpingotomy increases the futures chances of natural conception as opposed to salpingectomy.
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Affiliation(s)
- Funlayo Odejinmi
- Whipps Cross University Hospital, Barts Health NHS Trust, London, UK
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Affiliation(s)
- Thomas D'Hooghe
- Leuven University Fertility Centre, Department Obstetrics and Gynecology, University Hospital Gasthuisberg, KU Leuven, 3000 Leuven, Belgium; Department of Development and Regeneration, Group Biomedical Sciences, KU Leuven, 3000 Leuven, Belgium.
| | - Carla Tomassetti
- Leuven University Fertility Centre, Department Obstetrics and Gynecology, University Hospital Gasthuisberg, KU Leuven, 3000 Leuven, Belgium; Department of Development and Regeneration, Group Biomedical Sciences, KU Leuven, 3000 Leuven, Belgium
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Mol F, van Mello NM, Strandell A, Strandell K, Jurkovic D, Ross J, Barnhart KT, Yalcinkaya TM, Verhoeve HR, Graziosi GCM, Koks CAM, Klinte I, Hogström L, Janssen ICAH, Kragt H, Hoek A, Trimbos-Kemper TCM, Broekmans FJM, Willemsen WNP, Ankum WM, Mol BW, van Wely M, van der Veen F, Hajenius PJ. Salpingotomy versus salpingectomy in women with tubal pregnancy (ESEP study): an open-label, multicentre, randomised controlled trial. Lancet 2014; 383:1483-1489. [PMID: 24499812 DOI: 10.1016/s0140-6736(14)60123-9] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Tubal ectopic pregnancy can be surgically treated by salpingectomy, in which the affected Fallopian tube is removed, or salpingotomy, in which the tube is preserved. Despite potentially increased risks of persistent trophoblast and repeat ectopic pregnancy, salpingotomy is often preferred over salpingectomy because the preservation of both tubes is assumed to offer favourable fertility prospects, although little evidence exists to support this assumption. We aimed to assess whether salpingotomy would improve rates of ongoing pregnancy by natural conception compared with salpingectomy. METHODS In this open-label, multicentre, international, randomised controlled trial, women aged 18 years and older with a laparoscopically confirmed tubal pregnancy and a healthy contralateral tube were randomly assigned via a central internet-based randomisation program to receive salpingotomy or salpingectomy. The primary outcome was ongoing pregnancy by natural conception. Differences in cumulative ongoing pregnancy rates were expressed as a fecundity rate ratio with 95% CI, calculated by Cox proportional-hazards analysis with a time horizon of 36 months. Secondary outcomes were persistent trophoblast and repeat ectopic pregnancy (expressed as relative risks [RRs] with 95% CIs) and ongoing pregnancy after ovulation induction, intrauterine insemination, or IVF. The researchers who collected data for fertility outcomes were masked to the assigned intervention, but patients and the investigators who analysed the data were not. All endpoints were analysed by intention to treat. We also did a (non-prespecified) meta-analysis that included the findings from the present trial. This trial is registered, number ISRCTN37002267. FINDINGS 446 women were randomly assigned between Sept 24, 2004, and Nov 29, 2011, with 215 allocated to salpingotomy and 231 to salpingectomy. Follow-up was discontinued on Feb 1, 2013. The cumulative ongoing pregnancy rate was 60·7% after salpingotomy and 56·2% after salpingectomy (fecundity rate ratio 1·06, 95% CI 0·81-1·38; log-rank p=0·678). Persistent trophoblast occurred more frequently in the salpingotomy group than in the salpingectomy group (14 [7%] vs 1 [<1%]; RR 15·0, 2·0-113·4). Repeat ectopic pregnancy occurred in 18 women (8%) in the salpingotomy group and 12 (5%) women in the salpingectomy group (RR 1·6, 0·8-3·3). The number of ongoing pregnancies after ovulation induction, intrauterine insemination, or IVF did not differ significantly between the groups. 43 (20%) women in the salpingotomy group were converted to salpingectomy during the initial surgery because of persistent tubal bleeding. Our meta-analysis, which included our own results and those of one other study, substantiated the results of the trial. INTERPRETATION In women with a tubal pregnancy and a healthy contralateral tube, salpingotomy does not significantly improve fertility prospects compared with salpingectomy. FUNDING Netherlands Organisation for Health Research and Development (ZonMW), Region Västra Götaland Health & Medical Care Committee.
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Affiliation(s)
- Femke Mol
- Centre for Reproductive Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands.
| | - Norah M van Mello
- Department of Obstetrics and Gynaecology, Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands
| | | | | | - Davor Jurkovic
- King's Early Pregnancy Unit, King's College Hospital, London, UK; Department of Obstetrics and Gynaecology, University College London Hospital, London, UK
| | - Jackie Ross
- King's Early Pregnancy Unit, King's College Hospital, London, UK
| | - Kurt T Barnhart
- Penn Fertility Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | | | | | | | | | | - Harry Kragt
- Reinier de Graaf Hospital, Delft, Netherlands
| | - Annemieke Hoek
- University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | | | | | | | - Willem M Ankum
- Department of Obstetrics and Gynaecology, Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands
| | - Ben W Mol
- Department of Obstetrics and Gynaecology, Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands; School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, SA, Australia
| | - Madelon van Wely
- Centre for Reproductive Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands
| | - Fulco van der Veen
- Centre for Reproductive Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands
| | - Petra J Hajenius
- Department of Obstetrics and Gynaecology, Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands
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Capmas P, Bouyer J, Fernandez H. Treatment of ectopic pregnancies in 2014: new answers to some old questions. Fertil Steril 2014; 101:615-20. [DOI: 10.1016/j.fertnstert.2014.01.029] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 01/16/2014] [Accepted: 01/16/2014] [Indexed: 10/25/2022]
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Methotrexate treatment of ectopic pregnancies does not affect ovarian reserve in in vitro fertilization patients. Fertil Steril 2014; 101:337-8. [DOI: 10.1016/j.fertnstert.2013.11.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 11/08/2013] [Indexed: 11/22/2022]
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Medical treatment of ectopic pregnancy: a committee opinion. Fertil Steril 2013; 100:638-44. [DOI: 10.1016/j.fertnstert.2013.06.013] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Accepted: 06/07/2013] [Indexed: 10/26/2022]
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Fernandez H, Capmas P, Lucot JP, Resch B, Panel P, Bouyer J. Fertility after ectopic pregnancy: the DEMETER randomized trial. Hum Reprod 2013; 28:1247-53. [DOI: 10.1093/humrep/det037] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Parazzini F, Ricci E, Cipriani S, Chiaffarino F, Chiantera V, Bulfoni G. Temporal Trend in the Frequency of Ectopic Pregnancies in Lombardy, Italy. Gynecol Obstet Invest 2013; 75:210-4. [DOI: 10.1159/000346173] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 11/28/2012] [Indexed: 11/19/2022]
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Beall S, DeCherney AH. Management of tubal ectopic pregnancy: methotrexate and salpingostomy are preferred to preserve fertility. Fertil Steril 2012; 98:1118-20. [PMID: 22884016 DOI: 10.1016/j.fertnstert.2012.07.1115] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Accepted: 07/13/2012] [Indexed: 11/16/2022]
Affiliation(s)
- Stephanie Beall
- National Institutes of Health, Reproductive Endocrinology and Infertility, Bethesda, Maryland, USA
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