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Lutfi A, Hayes-Ryan D, Cottrell E, Greene RA. Systemic methotrexate (MTX) in early pregnancy: a retrospective study of a tertiary maternity hospital. Ir J Med Sci 2024:10.1007/s11845-024-03748-9. [PMID: 38980553 DOI: 10.1007/s11845-024-03748-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 06/30/2024] [Indexed: 07/10/2024]
Abstract
BACKGROUND Methotrexate (MTX) is used in clinical practice as a medical treatment option in patients with early pregnancy complications like ectopic pregnancy. AIMS To review systemic MTX therapy use in the first trimester of pregnancy in our hospital and to examine subsequent clinical outcomes. METHODS Retrospective review of all women treated with systemic MTX in early pregnancy identified from electronic prescription records from 1 January 2018 to 31 December 2020 at Cork University Maternity Hospital, Ireland. Relevant data was transcribed from electronic health records. RESULTS Indications for treatment were tubal ectopic pregnancy (70%, n = 51), persistent pregnancy of unknown location (22%, n = 16) and caesarean scar pregnancy (7%, n = 5). Treatment was successful in 88% (n = 44) of tubal ectopic pregnancies with 73% (n = 37) and 14% (n = 7) of women receiving a single dose and repeated doses, respectively. Only 8% (n = 4) of tubal ectopic pregnancies required emergency surgery for subsequent tubal rupture. In 93% (n = 15) of cases of persistent pregnancy of unknown location, treatment was successful with one patient requiring uterine evacuation. Women with caesarean scar pregnancy were treated with combined MTX and uterine evacuation without complication. CONCLUSIONS The efficacy of medical treatment with systemic MTX for confirmed tubal ectopic pregnancy in our hospital is in line with national and international standards. Careful consideration should be given to treating caesarean scar pregnancy and persistent pregnancy of unknown location with systemic MTX. Systemic MTX use guided by clinicians specialised in early pregnancy complications and safe medication practices may improve treatment success and reduce adverse events.
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Affiliation(s)
- Ahmed Lutfi
- Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, Cork, Ireland.
| | - Deirdre Hayes-Ryan
- Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, Cork, Ireland
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
- Department of Obstetrics and Gynaecology, National Perinatal Epidemiology Centre, University College Cork, Cork, Ireland
| | | | - Richard A Greene
- Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, Cork, Ireland
- Department of Obstetrics and Gynaecology, National Perinatal Epidemiology Centre, University College Cork, Cork, Ireland
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Yeniocak AS, Tercan C, Dagdeviren E, Arabacı O, Genc EE. Evaluation of a scoring system to predict treatment success with single-dose methotrexate in ectopic pregnancy. Arch Gynecol Obstet 2024; 309:2047-2055. [PMID: 38488896 DOI: 10.1007/s00404-024-07458-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 03/04/2024] [Indexed: 03/17/2024]
Abstract
PURPOSE This study sought to assess the efficacy of a newly developed scoring system in predicting treatment outcomes for ectopic pregnancy among patients undergoing single-dose methotrexate therapy. The primary research question centered on the reliability and predictive accuracy of objective parameters in determining methotrexate therapy success. METHODS Conducted as a retrospective single-center cohort study, data from 172 ectopic pregnancy patients treated with methotrexate between January 2021 and January 2023 were analyzed. Parameters including adnexal mass size, peritoneal fluid presence, yolk sac identification, endometrial thickness, ectopic pregnancy location, and initial B-hCG levels were meticulously evaluated for their association with treatment outcomes. RESULTS Following the exclusion of 21 emergency surgery cases, the final analysis comprised 151 patients. Notable associations were observed between specific parameters (fetal cardiac activity, adnexal mass size > 3.5 cm, peritoneal fluid presence, yolk sac identification, endometrial thickness > 10 mm, and initial B-hCG levels) and treatment outcomes (p < 0.001). Additionally, the novel scoring system demonstrated promising predictive performance. At a cutoff of 2.50, it achieved a sensitivity of 91.7% and a specificity of 59.7%. Increasing the cutoff to 3.50 resulted in a sensitivity of 94.0%, with a specificity of 46.3%. CONCLUSION Objective parameters, particularly those integrated into the developed scoring system, exhibited substantial associations with methotrexate therapy outcomes in ectopic pregnancy. These findings underscore the potential of an objective scoring model to significantly influence clinical decision-making in therapy, offering avenues for enhanced prognostication and patient care in treatment outcomes.
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Affiliation(s)
- Ali Selcuk Yeniocak
- Department of Obstetrics and Gynecology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey.
| | - Can Tercan
- Department of Obstetrics and Gynecology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Emrah Dagdeviren
- Department of Obstetrics and Gynecology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Onur Arabacı
- Department of Obstetrics and Gynecology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Emine Elif Genc
- Department of Obstetrics and Gynecology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
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Dayan-Schwartz A, Abd Elgani S, Abdul-Ghani T, Kogan L, Reiss A, Tal A. Pharmacological treatment of ectopic pregnancy: Accuracy, safety and cost-effectiveness of day 1-7 β-hCG measurements. Int J Gynaecol Obstet 2024. [PMID: 38619463 DOI: 10.1002/ijgo.15511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 03/09/2024] [Accepted: 03/18/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVE The aim of the present study was to compare accuracy, safety and cost-effectiveness of three β-hCG measurements protocols, applied in managing ectopic pregnancies (EP) with methotrexate (MTX): (1) day 1 to 7 β-hCG levels, (2) day 1 to 4 β-hCG levels and (3) day 4 to 7 β-hCG levels. METHODS Cost-minimization analysis (CMA) based on a retrospective study of patients treated with single-dose MTX for EP, was evaluated at a single institution between January 2001 to May 2021. Successful MTX treatment was defined as no surgical intervention. We evaluated safety by analyzing cases of day 4 interventions and cases of inconsistency between the different protocols. Predicting accuracy was assessed by the area under the receiver operating characteristic (AUC) curve. RESULTS A total of 229 patients with single dose MTX treatment were included. Overall, 184 (80.3%) patients were treated successfully with a single dose of MTX. For days 1 and 7 the optimal cutoff point was 7% reduction in β-hCG levels with sensitivity, specificity and PPV of 76.6% (69.9-82.5, 95% CI), 75.5% (60.5-87.1, 95% CI) and 92.8% (88.4-95.6, 95% CI), respectively. There was no significant difference between the protocols' AUC. None of the patients had any change of management during their day 4 visit in our 20 years of records. The cost for each visit day (day 4 and 7) was calculated with a total cost of 251 USD per patient. CONCLUSION Patients treated with MTX for EP, measurement of day 1 and day 7 β-hCG serum levels has a cost minimization advantage and is not inferior to the traditional protocol for predictive accuracy and safety.
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Affiliation(s)
- Adi Dayan-Schwartz
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Suzan Abd Elgani
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
| | | | - Liron Kogan
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
| | - Ari Reiss
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Alon Tal
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Abuduxukuer R, Chen X, Ni J, Li S, Lu W. Day 4 and day 0 neutrophil-to-lymphocyte ratios as predictors of treatment failure with single-dose methotrexate for ectopic pregnancies. Int J Gynaecol Obstet 2024; 165:131-137. [PMID: 38031149 DOI: 10.1002/ijgo.15248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 10/26/2023] [Accepted: 10/30/2023] [Indexed: 12/01/2023]
Abstract
OBJECTIVE To evaluate changes in the neutrophil-to-lymphocyte ratio (NLR) between day 4 and day 0 in ectopic pregnancy (EP) patients treated with single-dose methotrexate (MTX) and investigate its predictive value for treatment outcome. METHODS A total of 406 EP patients receiving single-dose MTX therapy at Shanghai First Maternity and Infant Hospital from January 10, 2013 to September 30, 2019 were studied. A multivariate model was constructed to predict treatment outcome. RESULTS Among the 406 patients, 281 were treated successfully. Treatment success declined significantly when NLR decreased by less than 23% (74.8% vs 58.5%, P = 0.004). Multivariate regression analysis identified NLR reduction of less than 23% on day 4 (odds ratio [OR] 2.09, 95% confidence interval [CI] 1.27-3.44), a human chorionic gonadotropin (hCG) decrease of 15% or less (OR 3.17, 95% CI 1.62-6.34), and an hCG increase of more than 15% on day 4 (OR 5.47, 95% CI 3.05-10.22) as independent risk factors for single-dose MTX treatment failure. The final predictive model had a sensitivity of 0.768 and a specificity of 0.569, using a cut-off value of 3. The area under the receiver operating characteristic curve was 0.712. Patients with a predictive score of ≥3 were more likely to fail single-dose MTX therapy. CONCLUSION The present study concluded that an NLR decrease of less than 23% on day 4, a plateau or increase in serum hCG on day 4, and an hCG value greater than 1000 mIU/mL on day 0 were predictors of single-dose MTX treatment failure in EP patients.
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Affiliation(s)
- Rukeyemu Abuduxukuer
- Department of Gynecology, School of Medicine, Shanghai First Maternity and Infant Hospital, Tong Ji University, Shanghai, P.R. China
- Shanghai Key Laboratory of Maternal and Fetal Medicine, Shanghai First Maternity and Infant Hospital, Shanghai, P.R. China
| | - Xiaoyue Chen
- Department of Gynecology, School of Medicine, Shanghai First Maternity and Infant Hospital, Tong Ji University, Shanghai, P.R. China
- Shanghai Key Laboratory of Maternal and Fetal Medicine, Shanghai First Maternity and Infant Hospital, Shanghai, P.R. China
| | - Jingyi Ni
- Department of Clinical Research Center, School of Medicine, Shanghai First Maternity and Infant Hospital, Tong Ji University, Shanghai, P.R. China
| | - Shuangdi Li
- Department of Gynecology, School of Medicine, Shanghai First Maternity and Infant Hospital, Tong Ji University, Shanghai, P.R. China
- Shanghai Key Laboratory of Maternal and Fetal Medicine, Shanghai First Maternity and Infant Hospital, Shanghai, P.R. China
| | - Wen Lu
- Department of Gynecology, School of Medicine, Shanghai First Maternity and Infant Hospital, Tong Ji University, Shanghai, P.R. China
- Shanghai Key Laboratory of Maternal and Fetal Medicine, Shanghai First Maternity and Infant Hospital, Shanghai, P.R. China
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Aiob A, Yousef H, Abu Shqara R, Mustafa Mikhail S, Odeh M, Lowenstein L. Risk factors and prediction of ectopic pregnancy rupture following methotrexate treatment: A retrospective cohort study. Eur J Obstet Gynecol Reprod Biol 2023; 285:181-185. [PMID: 37146508 DOI: 10.1016/j.ejogrb.2023.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/21/2023] [Accepted: 04/28/2023] [Indexed: 05/07/2023]
Abstract
OBJECTIVE Ectopic pregnancy (EP) rupture after methotrexate (MTX) treatment can have severe consequences. We examined clinical characteristics and beta-hCG trends that may predict EP rupture after MTX treatment. STUDY DESIGN In this 10-year retrospective study of 277 women with an EP, we compared clinical, sonographic and beta-hCG trends, before and after MTX treatment, between those who did and did not have an EP rupture after MTX treatment. RESULTS EP rupture was diagnosed in 41 women (15.1%) within 25 days of MTX treatment, and was correlated with higher parity and advanced pregnancy age: 2(0-5) vs. 1(0-6), P = 0.027 and 6.6(4.2-9.8) vs. 6.1(4-9.5), P = 0.045. EP rupture was also correlated with higher beta-hCG levels on days 0, 4 and 7 of MTX treatment: (2063 vs. 920 mIU/ml), (3221 vs. 921 mIU/ml) and (2368 vs. 703 mIU/ml), respectively, P < 0.001, for all. An increase of beta-hCG by>14% during days 0-4 showed a sensitivity of 71.4% CI 95% [55.4%-84.3%] and a specificity of 67.5% CI 95% [61.1%-73.6%] for predicting EP rupture after MTX treatment. Beta-hCG > 910 mIU/ml on day 0 showed a sensitivity of 80.9% CI 95% [66.7%-90.8%] and a specificity of 70.4% CI 95% [64.1%-76.3%] for predicting EP rupture after MTX treatment. A beta-hCG increase by>14% during days 0-4, and a beta-hCG value > 910 mUI/mL on day 0 were associated with increased risks of EP rupture after MTX treatment; the odds ratios were 6.4 and 10.5, respectively. Odds ratios were 8.06 [CI 95% (3.70-17.56)], P < 0.001 for every percent rise in beta-hCG during days 0-4; 1.37 [CI 95% (1.06-1.86)], P = 0.046 for every week change in gestational age; and 1.001 [CI 95% (1.000-1.001)], P < 0.001 for every unit rise in beta-hCG at day 0. CONCLUSION Beta-hCG > 910 mIU/ml at day 0, a rise in beta-hCG by>14% during days 0-4, and more advanced gestational age were associated with EP rupture after MTX treatment.
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Affiliation(s)
- Ala Aiob
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel; Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel.
| | - Haddad Yousef
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel
| | - Raneen Abu Shqara
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel; Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Susana Mustafa Mikhail
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel; Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Marwan Odeh
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel; Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Lior Lowenstein
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel; Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
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Clinical Presentation as a Predictor of the Response to Methotrexate Therapy in Patients with Ectopic Pregnancy. J Pregnancy 2022; 2022:5778321. [PMID: 36479045 PMCID: PMC9722302 DOI: 10.1155/2022/5778321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 11/15/2022] [Accepted: 11/18/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose Ectopic pregnancy can be fatal if not diagnosed and timely treated. There is an increase in ectopic pregnancy rate which attributes in part to fertility medications and procedures and early diagnosis. Methotrexate, a folic acid antagonist, is widely used in the medical treatment of ectopic pregnancy. Many studies examined the safety and success rate of methotrexate looking into factors affecting the success rate, if the patient may present with symptoms such as abdominal pain, and some consider this as impeding rupture and it might affect the success of medical treatment. This study evaluates the success rate of methotrexate treatment outcomes in regard to presentation and looks into other factors that can help choosing a single or multiple dose modality. Methods This is a retrospective review of 154 cases of ectopic pregnancy treated with methotrexate from January 2011 to December 2020 at King Khalid University Hospital (KKUH). Demographic data, clinical presentation, treatment progress, and outcome and failure rate were collected and analyzed. Student's t-test was used for statistical analysis of associations in SPSS. Results 154 patients were treated with MTX; of those patients, 25 received more than one dose. The difference between the responses to MTX treatment in symptomatic and asymptomatic individuals was not significant (p = 0.267). 131 (85%) had successful treatment. There were no associations between patient BMI, ectopic mass size, or ectopic mass site, the presence or absence of pelvic fluid on ultrasound at diagnosis, and the treatment success rate. There was a significant decline in the treatment success rate with increasing β-hCG levels on the presentation day (p = 0.035) and on day 4 (p value <0.001) of treatment. Conclusion MTX treatment can be used to manage symptomatic patients with ectopic pregnancy. The success rate in symptomatic patients is not different from that in asymptomatic patients. β - hCG levels > 5000 IU/L. Pretreatment and on day 4 posttreatment is associated with higher failure rate.
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Yu Y, Li Y, Yang X, Fan Q, Cao D, Wang Y. Daily variations and levels of human chorionic gonadotropin before methotrexate treatment as predictors of treatment success. J Obstet Gynaecol Res 2022; 48:3128-3136. [PMID: 36056536 DOI: 10.1111/jog.15413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 08/11/2022] [Accepted: 08/20/2022] [Indexed: 12/01/2022]
Abstract
AIM The aim of this study is to investigate the role of human chorionic gonadotropin (hCG) daily variations and levels prior to methotrexate treatment as predictors for treatment outcome. METHODS This retrospective study included patients who had a sonographically confirmed ectopic pregnancy at the International Peace Maternity and Child Health Hospital between November 2015 and June 2020. The associations of hCG levels and daily variations with the treatment success were evaluated by multivariable logistic regression and receiver operator characteristic (ROC) curve. Establish a nomogram that predicts how methotrexate (MTX) therapy will turn out. The performance of the model was assessed utilizing concordance index, receiver operating characteristic curves, and calibration plots. RESULTS The median serum hCG levels before treatment and hCG daily variation in the failure group were higher than those in the success group (487.8 vs. 270.7 IU/L, -1.86% vs. 7.29%, both p < 0.01). According to the ROC curve analysis, the cutoff values of serum hCG level before treatment and daily variations were 617.35 IU/L and 1.76%/day. By multivariable logistic regression analysis, serum hCG levels before treatment (odds ratio [OR]: 1.001, 95% confidence interval [CI]: 1.000 ~ 1.001) and hCG daily variations were independently associated with the treatment success (OR: 1.033, 95% CI: 1.015 ~ 1.052). The nomogram was effective at predicting the outcome of MTX treatment with a receiver operating characteristic area under the curve of 0.717 (p < 0.001). The nomogram's calibration curve was almost parallel to the ideal diagonal line. CONCLUSION We successfully created a nomogram based on serum hCG levels before treatment and hCG daily changes to anticipate the result of MTX therapy, which could assist medical professionals in selecting therapeutic schedule for patients with tubal pregnancies.
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Affiliation(s)
- Yuchong Yu
- Department of Gynecologic Oncology, the International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Municipal Key Clinical Specialty of Gynecologic Oncology, Shanghai, China.,Shanghai Key Laboratory of Embryo Original Diseases Affifiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuhong Li
- Department of Gynecologic Oncology, the International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Municipal Key Clinical Specialty of Gynecologic Oncology, Shanghai, China.,Shanghai Key Laboratory of Embryo Original Diseases Affifiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoming Yang
- Department of Gynecologic Oncology, the International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Municipal Key Clinical Specialty of Gynecologic Oncology, Shanghai, China.,Shanghai Key Laboratory of Embryo Original Diseases Affifiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qiong Fan
- Department of Gynecologic Oncology, the International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Municipal Key Clinical Specialty of Gynecologic Oncology, Shanghai, China.,Shanghai Key Laboratory of Embryo Original Diseases Affifiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dan Cao
- Department of Gynecologic Oncology, the International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Municipal Key Clinical Specialty of Gynecologic Oncology, Shanghai, China.,Shanghai Key Laboratory of Embryo Original Diseases Affifiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yudong Wang
- Department of Gynecologic Oncology, the International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Municipal Key Clinical Specialty of Gynecologic Oncology, Shanghai, China.,Shanghai Key Laboratory of Embryo Original Diseases Affifiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Time to resolution of tubal ectopic pregnancy following methotrexate treatment: A retrospective cohort study. PLoS One 2022; 17:e0268741. [PMID: 35609041 PMCID: PMC9129037 DOI: 10.1371/journal.pone.0268741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 05/06/2022] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To determine the time to resolution of tubal ectopic pregnancy after methotrexate treatment. METHODS A 14-year retrospective cohort study was performed from 2004-2018 and assessed 216 women treated with single-dose methotrexate for tubal ectopic pregnancy. Women were treated using a single-dose protocol of intramuscular methotrexate (50mg/m2) for confirmed tubal ectopic pregnancy on ultrasound. Ectopic pregnancies were included if the ectopic pregnancy mass was <35mm, no evidence of rupture and no embryonic cardiac activity. Serum hCG was measured on day 1, 4 and 7 of treatment and then at standard weekly intervals until resolution. Where there was not a ≥15% decline in hCG from day 4 and day 7, a second dose of methotrexate was administered. The primary outcome was time to resolution (days), with serum hCG <5 IU/L considered resolved. The secondary outcome was need for rescue surgery. RESULTS Among women who did not proceed to surgery, the median time to resolution was 22 days (IQR 14,34). Time to resolution and need for rescue surgery increased with baseline hCG. When hCG was <1000 IU/L, the median was 20 days (IQR 13,29) but 34.5 days (IQR 22,48) with hCG >2000 IU/L. Early hCG trends were predictive of time to resolution and likelihood of rescue surgery; a hCG rise of >1000 IU/L between Days 1-4 increased time to resolution to 61 days (IQR 35,80) and an odds ratio of rescue surgery of 28.6 (95% C.I. 5.3,155.4). CONCLUSION The median time to resolution for ectopic pregnancies treated with methotrexate is 22 days and associated with baseline hCG levels. The predictive value of baseline hCG may be useful in clinical decision making and counselling women considering methotrexate for ectopic pregnancy.
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ÇETİN F, BAYRAMOĞLU TEPE N, SUCU S, BADEMKIRAN MH, KUTLAR İ. Analysis of multiple-dose methotrexate therapy in tubal ectopic pregnancies. CUKUROVA MEDICAL JOURNAL 2022. [DOI: 10.17826/cumj.1037172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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10
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Factors Associated with Ruptured Ectopic Pregnancy: A 10-Year Review at a District Hospital in Ghana. Obstet Gynecol Int 2022; 2022:1491419. [PMID: 35295562 PMCID: PMC8920631 DOI: 10.1155/2022/1491419] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/20/2022] [Accepted: 02/11/2022] [Indexed: 11/17/2022] Open
Abstract
Background Approximately 1–2% of all pregnancies are ectopic. Despite a decline in ectopic pregnancy-related mortality, there is still a paucity of information on the factors associated with clinical presentation and outcomes in Sub-Saharan Africa which is essential in determining the most appropriate treatment modalities. Methods We performed a ten-year retrospective chart review of cases of ectopic pregnancies managed at the Lekma hospital and assessed them for peculiar risk factors, clinical presentation, and outcomes. Associations between patients' sociodemographic characteristics, clinical presentation, and treatment outcome were evaluated using multiple logistic regression and reported as adjusted odds ratios (AOR). The confidence interval (CI) was set at 95%, and a p value <0.05 were considered significant. Results Over the ten-year period, there were 115 ectopic pregnancies and 14,450 deliveries (7.9/1,000). The mean age ± standard deviation of the 115 patients was 27.61 ± 5.56. More than half of the patients were single (59/115, 51.3%). The majority (71.3%) of the patients presented with a ruptured ectopic pregnancy. After adjusting for covariates, the odds of an ectopic pregnancy presenting as ruptured among single patients was 2.63 times higher than that of married patients (AOR = 3.63, 95% CI: 1.33–9.93, p=0.01). Ectopic pregnancies located in the isthmic region of the tube had a 77% lower odds of presenting as ruptured than those located in the ampullary region (AOR = 0.23, 95% CI: 0.07–0.74, p=0.01). The odds of rupturing were 1.69 times increased for every additional week after the missed period (AOR = 2.69, 95% CI: 1.56–4.64, p < 0.01). No mortalities were reported as a result of an ectopic pregnancy. Conclusion Most of the cases of ectopic pregnancy presented ruptured. Marital status and period of amenorrhoea were significantly associated with rupture.
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11
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Ruptured ectopic pregnancies following methotrexate treatment: clinical course and predictors for improving patient counseling. Reprod Sci 2022; 29:1209-1214. [DOI: 10.1007/s43032-022-00881-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 02/07/2022] [Indexed: 10/19/2022]
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Cardall AK, Jacobson JC, Prager S, Flynn AN, Russo J. Medical management of ectopic pregnancy in a family planning clinic: a case series. Contraception 2022; 109:68-72. [PMID: 35031302 DOI: 10.1016/j.contraception.2021.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 11/01/2021] [Accepted: 11/06/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate safety of medical management of ectopic pregnancy in a free-standing family planning clinic setting. METHODS We retrospectively reviewed cases of ectopic pregnancy between January 2014 and December 2018 which were identified using a "Beta Board" tracking system. Planned Parenthood of Orange and San Bernardino Counties staff added patients the "Beta Board" if they had a positive urine pregnancy test without definitive ultrasound diagnosis of intrauterine pregnancy and/or symptoms suggestive of ectopic pregnancy, such as vaginal bleeding and cramping. Patients were included in the study if they had received a final diagnosis of ectopic pregnancy. RESULTS Of 5083 patients tracked via the Beta Board, 260 patients presented to a Planned Parenthood free-standing, family planning clinic with ectopic pregnancy. Ninety-five patients were treated with methotrexate entirely at the clinic. There were no deaths. Four ectopic pregnancies ruptured and eight required surgery. CONCLUSION Treatment of ectopic pregnancy with methotrexate in the family planning clinic setting can be safe and effective with reassuring outcomes that are similar to the hospital setting.
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Affiliation(s)
- Anna K Cardall
- School of Medicine, University of California, Irvine, Irvine, California, 1001 Health Sciences Rd, Irvine CA 92617.
| | - Janet C Jacobson
- Planned Parenthood of Orange and San Bernardino Counties, 700 S. Tustin St. Orange, CA 92866.
| | - Sarah Prager
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, 1959 NE Pacific St. Seattle WA, 98195.
| | - Anne N Flynn
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA, 3400 Spruce St, Philadelphia, PA 19104.
| | - Jennefer Russo
- Department of Obstetrics and Gynecology, Harbor UCLA Medical Center, Torrance, CA, 1000 W Carson St, Torrance, CA 90502.
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Yu H, Wang W, Liang H, Wang K, Ling B. Severe Adverse Toxic Effects of Low-Dose Methotrexate Treatment on an Ectopic Pregnancy Patient With Methylenetetrahydrofolate Reductase Mutations: A Case Report. Front Med (Lausanne) 2021; 8:738315. [PMID: 34869432 PMCID: PMC8636773 DOI: 10.3389/fmed.2021.738315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 10/13/2021] [Indexed: 11/28/2022] Open
Abstract
Background: Low-dose methylenetetrahydrofolate (LD-MTX) has been widely used for the treatment of the ectopic pregnancy (EP) for many decades, and related severe adverse toxic effects are rare. Current studies have shown that the polymorphisms of methylenetetrahydrofolate reductase (MTHFR) gene can decrease the MTX clearance, leading to the metabolite accumulation. However, there is a lack of literature report on an MTHFR gene polymorphism associated with adverse toxic effects resulting from the use of LD-MTX in an EP. Case Presentation: We report a rare case of a 38-year-old female who developed persistent fever, grade IV myelosuppression, skin lesions, mucositis, and liver injury after single dose of LDMTX to treat EP. The personalized genetic testing showed that MTHFR TT (677C>T) and MTHFR AA (1298A>C) were detected. Gradually, the symptoms improved after calcium leucovorin (CF) rescue, continuous renal replacement therapy (CRRT), promoting blood system regeneration, and multiple supportive treatments. Conclusion: This is the first report on the serious adverse toxic effects of LD-MTX on an EP patient with MTHFR mutations. We aim to alert obstetricians and gynecologists to this rare condition. The unexpected life-threatening toxicity with LD-MTX should be highly considered and recognized early. In particular, some easily overlooked gastrointestinal, skin, and mucosal symptoms occur earlier than severe myelosuppression. When toxic effects are suspected, detecting the polymorphisms of an MTHFR gene and monitoring MTX concentration in blood could assist us to formulate individualized and active treatments.
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Affiliation(s)
- Huan Yu
- Department of Obstetrics and Gynaecology, China-Japan Friendship Hospital, Beijing, China
| | - Wenhui Wang
- Department of Obstetrics and Gynaecology, China-Japan Friendship Hospital, Beijing, China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Haiyan Liang
- Department of Obstetrics and Gynaecology, China-Japan Friendship Hospital, Beijing, China
| | - Kun Wang
- Department of Obstetrics and Gynaecology, China-Japan Friendship Hospital, Beijing, China
| | - Bin Ling
- Department of Obstetrics and Gynaecology, China-Japan Friendship Hospital, Beijing, China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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Dhanawat J, Pape J, Stuhlmann‐Laeisz C, Maass N, Freytag D, Gitas G, Alkatout I. Ectopic pregnancy in noncommunicating horn of unicornuate uterus: 3D-ultrasound and primary laparoscopic management. Clin Case Rep 2021; 9:e04261. [PMID: 34084520 PMCID: PMC8142796 DOI: 10.1002/ccr3.4261] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 01/23/2021] [Indexed: 11/12/2022] Open
Abstract
Unicornuate uterus with pregnancy in the noncommunicating rudimentary horn is extremely rare. Diagnosis requires awareness, high suspicion index, 3D ultrasound, and MRI. If missed, it can be catastrophic. Treatment varies across literature. We present a case where detection was done by 3D ultrasound and primary laparoscopic surgery done for treatment.
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Affiliation(s)
- Juhi Dhanawat
- Department of Gynecology and ObstetricsUniversity Hospitals Schleswig‐HolsteinKielGermany
| | - Julian Pape
- Department of Gynecology and ObstetricsUniversity Hospitals Schleswig‐HolsteinKielGermany
| | | | - Nicolai Maass
- Department of Gynecology and ObstetricsUniversity Hospitals Schleswig‐HolsteinKielGermany
| | - Damaris Freytag
- Department of Gynecology and ObstetricsUniversity Hospitals Schleswig‐HolsteinKielGermany
| | - Georgios Gitas
- Department of Gynaecology and ObstetricsUniversity Hospitals Schleswing‐HolsteinLeubeckGermany
| | - Ibrahim Alkatout
- Department of Gynecology and ObstetricsUniversity Hospitals Schleswig‐HolsteinKielGermany
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Kingsbury B, Sam D, Jeyasudha R, Thomas E, Rebekah G, Lionel J. Ectopic pregnancies: Catch them early, treat them wisely! J Family Med Prim Care 2020; 9:4911-4918. [PMID: 33209821 PMCID: PMC7652111 DOI: 10.4103/jfmpc.jfmpc_684_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/10/2020] [Accepted: 07/04/2020] [Indexed: 11/15/2022] Open
Abstract
Introduction: Ectopic pregnancy (EP) is a common condition encountered in Obstetrics and Gynecology. Different management protocols are currently available for haemodymanically stable patients but definitive recommendations is yet to be established, especially in developing countries with limited resources. Aim: To determine the outcome of EP in patients who are haemodynamically stable and to evaluate the factors that would predict success of specific management protocols in them. Methodology: Haemodynamically stable patients with HCG levels <1500 mIU/ml were recruited for expectant management, 1500–5000 mIU/ml were given MTX and those with >5000 mIU/ml were managed surgically. Results: The overall success rate for expectant management was 92.7% and that with MTX was 80%. Baseline HCG values was found to be the only significant factor for predictor of success of treatment in the expectant group (P 0.05). The size of mass seen on USG did not have a significant correlation with beta HCG values (P 0.257). Conclusion: Of all the predictors for success of treatment that have been studied, the initial HCG value alone remains of paramount importance. Women with initial values of HCG <1500 mIU/ml can be offered expectant management, with a much better assurance of success for those with values <1000 mIU/ml. Those with values <5000 mIU/ml can be given MTX, with single dose being sufficient most often for <3000 mIU/ml. The presence of fluid restricted to the pelvis on USG can be managed non-surgically. One should not opt for surgical management only on the basis of size of the adnexal mass on USG.
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Affiliation(s)
- Beena Kingsbury
- Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Dibu Sam
- Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, Tamil Nadu, India
| | - R Jeyasudha
- Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Elsy Thomas
- Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Grace Rebekah
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India
| | - Jessie Lionel
- Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, Tamil Nadu, India
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16
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Zhang J, Zhang Y, Gan L, Liu XY, Du SP. Predictors and clinical features of methotrexate (MTX) therapy for ectopic pregnancy. BMC Pregnancy Childbirth 2020; 20:654. [PMID: 33121473 PMCID: PMC7597060 DOI: 10.1186/s12884-020-03350-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 10/20/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ectopic pregnancy is a major life- and fertility-threatening women's health concern. As a result of advances in examination technology, an increasing number of ectopic pregnancies can be diagnosed early and treated with medical methods instead of surgery. The aim of this study was to summarize the clinical features and identify the predictors of success of methotrexate (MTX) treatment of ectopic pregnancy. METHODS This was a retrospective study of 238 ectopic pregnancies treated with MTX in the Department of Gynecology of Shaanxi Provincial People's Hospital from January 2017 to December 2017. RESULTS Patients were divided into two groups: the successful treatment group (n = 166) and the failed treatment group (n = 72). The overall success rate of MTX therapy for ectopic pregnancy was 69.75%. The mean initial beta-human chorionic gonadotropin (β-hCG) level was significantly lower in the successful treatment group than in the failed treatment group (2538.08 IU/L versus 3533.17 IU/L, P = 0.000). The treatment success rate of the group with an initial β-hCG concentration less than 4000 IU/L was significantly higher than that of the group with an initial β-hCG concentration greater than 4000 IU/L. However, the success rate of the group with an initial β-hCG concentration greater than 4000 IU/L was still relatively high (54.55%). β-hCG levels were significantly increased on the 4th day in the failed treatment group (P = 0.000). Compared to the initial β-hCG level, the day-4 β-hCG level increased by more than 8.21%, indicating that the treatment was effective. The diagnostic sensitivity was 88.6%, the specificity was 74.5%, and the area under the receiver operating characteristic (ROC) curve was 0.863 (95% confidence interval (CI): 0.805-0.920). CONCLUSIONS MTX therapy as a treatment option is safe and effective for asymptomatic, hemodynamically stable patients with ectopic pregnancies who are interested in conservative treatment, regardless of the serum β-hCG level or adnexal mass size. The change in the β-hCG level between the initial day and the 4th day is an effective and early predictive tool for the success of MTX therapy for ectopic pregnancy.
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Affiliation(s)
- Jing Zhang
- Shaanxi Provincial People's Hospital, Xian, 710068, Shaanxi, China
| | - Yu Zhang
- Shaanxi Provincial People's Hospital, Xian, 710068, Shaanxi, China
| | - Lu Gan
- Shaanxi Provincial People's Hospital, Xian, 710068, Shaanxi, China
| | - Xiao-Ying Liu
- Shaanxi Provincial People's Hospital, Xian, 710068, Shaanxi, China
| | - Shan-Ping Du
- Shaanxi Provincial People's Hospital, Xian, 710068, Shaanxi, China.
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17
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Leonardi M, Allison E, Lu C, Nadim B, Condous G. Prognostic accuracy of a novel methotrexate protocol for the resolution of tubal ectopic pregnancies. Eur J Obstet Gynecol Reprod Biol 2020; 247:186-190. [DOI: 10.1016/j.ejogrb.2020.02.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 02/12/2020] [Accepted: 02/17/2020] [Indexed: 10/25/2022]
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Fridman D, Hawkins E, Dar P, Chudnoff S, Rotenberg O, Chong W, Xie X, Mehta S, Levie M. Methotrexate Administration to Patients With Presumed Ectopic Pregnancy Leads to Methotrexate Exposure of Intrauterine Pregnancies. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:675-684. [PMID: 30244479 DOI: 10.1002/jum.14751] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 06/10/2018] [Accepted: 07/14/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To report clinical experience with methotrexate (MTX) treatment for suspected but not definite ectopic pregnancy (EP). METHODS This was a retrospective cohort study. All patients treated with MTX for presumed EP between 2000 and 2016 were included. Demographic, clinical, sonographic, and outcome data were collected and analyzed. RESULTS A total of 820 patients were treated with MTX, 692 (84.4%) of which were lacking definitive features of EP; 155 (22.4%) failed to follow up until complete resolution and were excluded. Retrospective sonographic categorization was applied to 537 patients; of those patients, 393 (73.2%) were categorized as probable EPs, 136 (25.3%) pregnancies of unknown location (PULs), and 8 (1.5%) probable intrauterine pregnancies (IUPs). Sixteen were eventually diagnosed with IUP: 6 from the probable EPs, 9 from the PULs, and 1 from the probable IUP group. Patients with final diagnosis of IUP had higher values of β-human chorionic gonadotropin as well as lower prevalence of adnexal mass (38% versus 74%; P = .003), higher prevalence of intracavitary fluid (44% versus 9%; P = .0004) and thicker endometrium (17.1 ± 11.8 versus 9.7 ± 5.6; P = .04). None of the sonographic parameters were able to distinguish patients with IUP. One patient of the 16 with IUP was diagnosed with a viable pregnancy, and 7 additional patients had a possible viable pregnancy. None of them elected to continue the pregnancy. CONCLUSIONS Most patients with suspected EP who are eligible for medical treatment lack definitive sonographic features of EP. Treatment with MTX in such cases should be delayed, as clinically reasonable, to improve the diagnosis and prevent inadvertent administration of MTX to patients with a viable IUP.
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Affiliation(s)
- Dmitry Fridman
- Department of Obstetrics, Gynecology, and Women's Health, Montefiore Medical Center, Bronx, New York, USA
| | - Eleanor Hawkins
- Department of Obstetrics, Gynecology, and Women's Health, Montefiore Medical Center, Bronx, New York, USA
| | - Peer Dar
- Department of Obstetrics, Gynecology, and Women's Health, Montefiore Medical Center, Bronx, New York, USA
| | - Scott Chudnoff
- Department of Obstetrics, Gynecology, and Women's Health, Montefiore Medical Center, Bronx, New York, USA
| | - Ohad Rotenberg
- Department of Obstetrics, Gynecology, and Women's Health, Montefiore Medical Center, Bronx, New York, USA
| | - Woojin Chong
- Department of Obstetrics, Gynecology, and Women's Health, Montefiore Medical Center, Bronx, New York, USA
| | - Xianhong Xie
- Department of Obstetrics, Gynecology, and Women's Health, Montefiore Medical Center, Bronx, New York, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Sukrant Mehta
- Department of Obstetrics, Gynecology, and Women's Health, Montefiore Medical Center, Bronx, New York, USA
| | - Mark Levie
- Department of Obstetrics, Gynecology, and Women's Health, Montefiore Medical Center, Bronx, New York, USA
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Hutchinson AP, Pereira N, Chung ER, Shah NJ, Zeku M, Chung PH, Rosenwaks Z. Risk factors and human chorionic gonadotropin trends in patients with ruptured tubal ectopic pregnancies despite methotrexate treatment. Gynecol Endocrinol 2019; 35:49-52. [PMID: 30322280 DOI: 10.1080/09513590.2018.1490406] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
This retrospective cohort study investigates the risk factors and beta-human chorionic gonadotropin (β-hCG) trends in patients with ruptured tubal ectopic pregnancies (EPs) despite methotrexate (MTX) treatment. All patients receiving MTX for sonographically confirmed tubal EPs at our fertility center between 2004 and 2014 were included. Baseline demographics and β-hCG trends of patients with EP rupture after MTX were compared to patients with resolved EPs after MTX. One-hundred-thirty-seven patients with EPs were treated with MTX during the study duration; 27 experienced EP rupture and 110 EP resolution. There was no difference in the baseline demographics or β-hCG levels on the day of MTX between the groups. Patients with ruptured EPs after MTX had higher β-hCG levels on day-4 (1223.9 ± 243.5 vs. 1111.2 ± 179.7 mIU/mL; p < .001) and day-7 (1156.9 ± 206.2 vs. 872.4 ± 690.2 mIU/mL; p < .001). The odds of EP rupture compared to EP resolution was 6.2 (95% CI 2.1-19.1), 13.7 (95% CI 4.8-38.9), and 3.0 (95% CI 1.2-7.2) times higher when the change in β-hCG levels was <5% between day-7 vs. day of MTX, day-7 vs. day-4, and day-4 vs. day of MTX, respectively. Our results demonstrate that ruptured tubal EPs despite MTX have <5% change in β-hCG levels between the day of MTX and day-4 or day-7 after MTX.
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Affiliation(s)
- Anne P Hutchinson
- a Department of Obstetrics and Gynecology , Weill Cornell Medical College , New York , NY , USA
| | - Nigel Pereira
- b The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine , New York , NY , USA
| | - Eric R Chung
- b The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine , New York , NY , USA
| | - Nirali J Shah
- a Department of Obstetrics and Gynecology , Weill Cornell Medical College , New York , NY , USA
| | - Megi Zeku
- b The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine , New York , NY , USA
| | - Pak H Chung
- b The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine , New York , NY , USA
| | - Zev Rosenwaks
- b The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine , New York , NY , USA
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20
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Uludag SZ, Kutuk MS, Dolanbay M, Ozgun MT, Eliyeva G, Altun O. Conservative management of interstitial pregnancies: experience of a single centre. J OBSTET GYNAECOL 2018. [DOI: 10.1080/01443615.2017.1417979] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Semih Zeki Uludag
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Mehmet Serdar Kutuk
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Mehmet Dolanbay
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Mahmut Tuncay Ozgun
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Gunel Eliyeva
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Ozguc Altun
- Departments of Obstetrics & Gynecology, Kayseri Education & Research Hospital, Kayseri, Turkey
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Safety and Efficacy of Uterine Artery Embolization in Ectopic Pregnancies Refractory to Systemic Methotrexate Treatment: A Single-Center Study. Cardiovasc Intervent Radiol 2017; 40:1351-1357. [PMID: 28462440 DOI: 10.1007/s00270-017-1664-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 04/21/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND To investigate the use of uterine artery embolization (UAE) to manage ectopic pregnancies that are refractory to systemic methotrexate (MTX) therapy and plagued by persistently high serum β-human chorionic gonadotrophin (hCG) levels and vaginal bleeding. The safety and efficacy of UAE were addressed. MATERIALS AND METHODS A retrospective review was conducted for thirteen patients (mean age 35.2 years; range 28-41 years), who were treated between December 2006 and June 2016. Each was subjected to UAE due to persistently high serum β-hCG levels and vaginal bleeding after systemic MTX therapy for ectopic pregnancy. Embolic agents used were non-spherical polyvinyl alcohol or gelatin sponge particles. Post-treatment follow-up was performed by monitoring for clinical signs of vaginal bleeding, serum β-hCG testing, and transvaginal US. Outcomes were technical success, clinical success, and complications. RESULTS Median follow-up period was 172.5 days (range 30-600 days). Technical success was achieved in all 13 patients (100%). In 10 patients, vaginal bleeding resolved after one UAE attempt (clinical success 76.0%). Rebleeding in other three (23.1%) was controlled through repeat UAE. Seven patients (53.8%) had additional dilatation and curettage to remove gestational sac remnants. All ectopic pregnancies were successfully treated by UAE, with normalization of serum β-hCG levels during follow-up monitoring (P = 0.01). Uterine preservation was achieved in all 13 patients, without major procedural complications. CONCLUSION UAE appears safe and effective as treatment of ectopic pregnancies marked by persistently high serum β-hCG levels and vaginal bleeding after systemic MTX treatment.
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