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Allegrini M, Legendre G, Dabi Y, Thubert T, Joste M, Lavoué V, Timoh KN. Local Injection of Methotrexate Ultrasound guided-transvaginal. J Gynecol Obstet Hum Reprod 2022; 51:102419. [PMID: 35667587 DOI: 10.1016/j.jogoh.2022.102419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 05/31/2022] [Accepted: 06/02/2022] [Indexed: 11/28/2022]
Abstract
Non-tubal ectopic pregnancies can be located in the uterine portion of the tube (interstitial or cornual), in the cervix (cervical), in a caesarean scar, in the ovary, or intra-abdominally. Even though they are rare, they are associated with a high mortality. Invasive surgeries such as cornuectomy and hysterectomy were common to treat them in case of hemorrhage. Thanks to recent advances in imaging techniques, diagnosis of non-tubal ectopic pregnancy is made earlier and conservative management has been developed in order to respect fertility of patients. Beyond these treatments, systemic or local injection of Methotrexate shows very good success. In the article, we aimed to describe the technics of vaginal injection of in situ methotrexate with ultrasound guidance.
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Affiliation(s)
- Marie Allegrini
- Department of Gynecology and Obstetrics and Human reproduction, CHU Rennes, Rennes, France
| | | | - Yohann Dabi
- Department of Obstetrics and Reproductive Medicine, Hôpital Tenon, Sorbonne University
| | - Thibault Thubert
- Department of Obstetrics and Gynecology, Nantes University Hospital, Nantes
| | - Marine Joste
- Department of Gynecology and Obstetrics and Human reproduction, CHU Rennes, Rennes, France
| | - Vincent Lavoué
- Department of Gynecology and Obstetrics and Human reproduction, CHU Rennes, Rennes, France
| | - Krystel Nyangoh Timoh
- Department of Gynecology and Obstetrics and Human reproduction, CHU Rennes, Rennes, France; University Rennes 1, France, INSERM, LTSI - UMR 1099
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Cillard L, Dabi Y, Fernandez H, Lavoué V, Timoh KN, Thubert T, Bouet PE, Legendre G. Management of non-tubal ectopic pregnancies in France: Results of a practice survey. J Gynecol Obstet Hum Reprod 2022; 51:102330. [DOI: 10.1016/j.jogoh.2022.102330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 01/30/2022] [Accepted: 01/31/2022] [Indexed: 11/26/2022]
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Treatment of ectopic pregnancy with methotrexate. Arch Gynecol Obstet 2019; 300:1093-1094. [PMID: 31321493 DOI: 10.1007/s00404-019-05248-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 07/10/2019] [Indexed: 10/26/2022]
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Rigopoulos P, Dardalas I, Pourzitaki C. Emphasis on the off-label use of methotrexate for ectopic pregnancy. Am J Obstet Gynecol 2019; 220:611-612. [PMID: 30807765 DOI: 10.1016/j.ajog.2019.02.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 02/19/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Panagiotis Rigopoulos
- Department of Clinical Pharmacology, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Dardalas
- Department of Clinical Pharmacology, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Chryssa Pourzitaki
- Department of Clinical Pharmacology, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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Bonin L, Pedreiro C, Moret S, Chene G, Gaucherand P, Lamblin G. Predictive factors for the methotrexate treatment outcome in ectopic pregnancy: A comparative study of 400 cases. Eur J Obstet Gynecol Reprod Biol 2016; 208:23-30. [PMID: 27888702 DOI: 10.1016/j.ejogrb.2016.11.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 10/08/2016] [Accepted: 11/15/2016] [Indexed: 11/24/2022]
Abstract
OBJECTIVE We sought to evaluate the global success rate of intramuscular methotrexate for the treatment of ectopic pregnancy, identify factors predictive of treatment success or failure, and study methotrexate tolerability in a large patient cohort. STUDY DESIGN For this single-center retrospective observational study, we retrieved the records of all women who had a clinically or echographically confirmed ectopic pregnancy with a Fernandez score <13 and who were treated according to a 1mg/kg intramuscular single-dose methotrexate protocol. Medical treatment failure was defined by an obligation to proceed to laparoscopy. Needing a second injection was not considered to be medical treatment failure. RESULTS Between February 2008 and November 2013 (69 months), 400 women received methotrexate for ectopic pregnancy. The medical treatment protocol was effective for 314 patients, i.e., an overall success rate of 78.5%. A single methotrexate dose was sufficient for 63.5% of the women and a second dose was successful for 73.2% of the remaining women. The medical treatment success rate fell as initial hCG levels climbed. The main factors associated with methotrexate failure included day (D) 0, D4 and D7 hCG levels, pretherapeutic blood progesterone, hematosalpinx at D0 and pain at D7. Early favorable kinetics of hCG levels was predictive of success. Methotrexate treatment was successful in 90% of women who had D0 hCG <1000IU/l. Methotrexate tolerability was good, with only 9% of the women reporting non-severe adverse effects. The fertility rate with delivery after medical treatment for ectopic pregnancy was 80.7%. CONCLUSION In this study, we showed that an initial hCG value <1000IU/l and favorable early HCG kinetics were predictive factors for the successful medical treatment of ectopic pregnancy by methotrexate, and hematosalpinx and pretherapeutic blood progesterone >5ng/ml at diagnosis were predictive of its failure. We also confirmed good tolerability for single-dose methotrexate protocols.
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Affiliation(s)
- Lucie Bonin
- Department of Obstetrics and Gynecology Surgery, Femme Mère Enfant Hospital, Lyon, Hospices Civils de Lyon, France
| | - Cécile Pedreiro
- Department of Obstetrics and Gynecology Surgery, Femme Mère Enfant Hospital, Lyon, Hospices Civils de Lyon, France
| | - Stéphanie Moret
- Clinical Research Associate, Hospices Civils de Lyon, Femme Mère Enfant University Hospital, Department of Obstetrics and Gynecology, Lyon, France
| | - Gautier Chene
- Department of Obstetrics and Gynecology Surgery, Femme Mère Enfant Hospital, Lyon, Hospices Civils de Lyon, France
| | - Pascal Gaucherand
- Department of Obstetrics and Gynecology Surgery, Femme Mère Enfant Hospital, Lyon, Hospices Civils de Lyon, France
| | - Géry Lamblin
- Department of Obstetrics and Gynecology Surgery, Femme Mère Enfant Hospital, Lyon, Hospices Civils de Lyon, France.
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Overview and guidelines of off-label use of methotrexate in ectopic pregnancy: report by CNGOF. Eur J Obstet Gynecol Reprod Biol 2016; 205:105-9. [DOI: 10.1016/j.ejogrb.2016.07.489] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 07/01/2016] [Accepted: 07/25/2016] [Indexed: 12/27/2022]
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Lagarce L, Bernard N, Carlier P, Phelipot-Lates S, Perault-Pochat MC, Drablier G, Bourneau-Martin D, Lainé-Cessac P. Méthotrexate pour grossesse extra-utérine : quels risques en cas de nouvelle grossesse ? Therapie 2016; 71:389-94. [DOI: 10.1016/j.therap.2015.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 12/14/2015] [Indexed: 12/27/2022]
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Debras E, Fernandez H, Pourcelot AG, Houllier M, Capmas P. [Medical management of interstitiel pregnancy by in situ methotrexate]. ACTA ACUST UNITED AC 2016; 45:673-8. [PMID: 26993077 DOI: 10.1016/j.jgyn.2015.11.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 11/06/2015] [Accepted: 11/24/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Interstitial pregnancy accounts for 3 to 11% of ectopic pregnancy; these pregnancies are the more frequently non-tubal ectopic pregnancy. Medical treatment can be used in case of unruptured interstitial pregnancy and is used more and more frequently to avoid hemorrhagic risk and risk of conversion to radical surgery when a surgical management is decided. However, a larger use of methotrexate in interstitial pregnancy and conditions of use are not clearly defined. The aim of this study is to report a series of unruptured interstitial pregnancy managed by in situ injection of methotrexate. WOMEN AND METHODS This retrospective observational study included women treated for an interstitial pregnancy between 2010 and 2013 in a teaching hospital. Medical management used was an in situ injection of methotrexate (1mg/kg) guided by vaginal sonography plus an intramuscular injection of methotrexate (1mg/kg) in the 48hours following in situ injection and 600mg of mifepristone when progesterone blood rate was more than 9ng/mL. A great decrease of serum hCG without surgery was considered a success. RESULTS Fourteen women had an interstitial pregnancy during the study period. Six were managed surgically in 5 cases for suspicion of uterine rupture and one for pregnancy of unknown location. Eight women had a medical management and the success rate was 100%. Mean time for decrease of serum hCG until 2 UI/L was 54.4 days [34.0-74.8]. No uterine rupture or immediate complication was reported. Five women out of 8 had a spontaneous pregnancy after management of interstitial pregnancy. CONCLUSION Medical management by in situ injection of methotrexate under sonographic guidance with an intramuscular injection within the 48hours following the in situ injection and mifepristone when ectopic pregnancy was active can be proposed in first-line therapy in case of unruptured interstitial pregnancy. This treatment has a great efficiency and low rate of complications.
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Affiliation(s)
- E Debras
- Service de gynécologie obstétrique, hôpital Bicêtre, groupement hospitalier universitaire Sud, AP-HP, 78, avenue du Général-Leclerc, 94275 Le Kremlin-Bicêtre cedex, France
| | - H Fernandez
- Service de gynécologie obstétrique, hôpital Bicêtre, groupement hospitalier universitaire Sud, AP-HP, 78, avenue du Général-Leclerc, 94275 Le Kremlin-Bicêtre cedex, France; Inserm, centre de recherche en épidémiologie et santé des populations (CESP), U1018, 94276 Le Kremlin-Bicêtre, France; Faculté de médecine, université Paris-Sud, 94276 Le Kremlin-Bicêtre, France
| | - A-G Pourcelot
- Service de gynécologie obstétrique, hôpital Bicêtre, groupement hospitalier universitaire Sud, AP-HP, 78, avenue du Général-Leclerc, 94275 Le Kremlin-Bicêtre cedex, France; Faculté de médecine, université Paris-Sud, 94276 Le Kremlin-Bicêtre, France
| | - M Houllier
- Service de gynécologie obstétrique, hôpital Bicêtre, groupement hospitalier universitaire Sud, AP-HP, 78, avenue du Général-Leclerc, 94275 Le Kremlin-Bicêtre cedex, France; Faculté de médecine, université Paris-Sud, 94276 Le Kremlin-Bicêtre, France
| | - P Capmas
- Service de gynécologie obstétrique, hôpital Bicêtre, groupement hospitalier universitaire Sud, AP-HP, 78, avenue du Général-Leclerc, 94275 Le Kremlin-Bicêtre cedex, France; Inserm, centre de recherche en épidémiologie et santé des populations (CESP), U1018, 94276 Le Kremlin-Bicêtre, France; Faculté de médecine, université Paris-Sud, 94276 Le Kremlin-Bicêtre, France.
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Nikodijevic K, Bricou A, Benbara A, Moreaux G, Nguyen C, Carbillon L, Poncelet C, Boujenah J. [Cornual pregnancy: Management and subsequent fertility]. ACTA ACUST UNITED AC 2015; 44:11-6. [PMID: 26678164 DOI: 10.1016/j.gyobfe.2015.10.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Accepted: 10/14/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Cornual pregnancy is a rare entity, representing 2% of ectopic pregnancies. Its management is poorly codified and often guided by the clinical situation. The aim of our study was to describe the management of cornual pregnancies, subsequent fertility, and obstetric outcomes according to the management. METHODS Observational retrospective unicentric study. Nineteen patients hospitalized for cornual pregnancy between 2006 and 2015 were included. The data was collected with medical records and a phone standardized questionnaire. Patients were managed according to hemodynamic status by either systemic or local methotrexate injection or surgical corneal resection. RESULTS Among the 19 patients, 32% (6) were treated by systemic injection (one failure treated by surgical treatment) and 68% (13) underwent surgical treatment by cornual resection. The median HCG rate decrease was 33 days (16-62). Among the twelve patients with a desire for a new pregnancy, 7 (58%) became pregnant without assisted reproductive technology (2 following medical treatment and 5 following surgical resection). Histological analysis of uterine horn showed proximal fallopian tube lesions in 76.9% of case (chronic salpingitis, endosalpingiosis and adenomyosis). CONCLUSION Cornual pregnancies are at high risk of hemorrhagic rupture. Ectopic recidive may occur. Fertility and obstetrical outcomes following cornual pregnancy are not affected whatever the initial treatment. Other studies are needed to aid clinical management according to HCG level and ultrasound features.
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Affiliation(s)
- K Nikodijevic
- Service de gynécologie-obstétrique, université Paris XIII-Bobigny, CHU Jean-Verdier, avenue du 14-Juillet, 93140 Bondy, France
| | - A Bricou
- Service de gynécologie-obstétrique, université Paris XIII-Bobigny, CHU Jean-Verdier, avenue du 14-Juillet, 93140 Bondy, France
| | - A Benbara
- Service de gynécologie-obstétrique, université Paris XIII-Bobigny, CHU Jean-Verdier, avenue du 14-Juillet, 93140 Bondy, France
| | - G Moreaux
- Service de gynécologie-obstétrique, université Paris XIII-Bobigny, CHU Jean-Verdier, avenue du 14-Juillet, 93140 Bondy, France
| | - C Nguyen
- Service de gynécologie-obstétrique, université Paris XIII-Bobigny, CHU Jean-Verdier, avenue du 14-Juillet, 93140 Bondy, France; Université Paris 13, Sorbonne Paris cité, UFR SMBH, 93140 Bobigny, France
| | - L Carbillon
- Service de gynécologie-obstétrique, université Paris XIII-Bobigny, CHU Jean-Verdier, avenue du 14-Juillet, 93140 Bondy, France; Université Paris 13, Sorbonne Paris cité, UFR SMBH, 93140 Bobigny, France
| | - C Poncelet
- Service de gynécologie-obstétrique, université Paris XIII-Bobigny, CHU Jean-Verdier, avenue du 14-Juillet, 93140 Bondy, France; Université Paris 13, Sorbonne Paris cité, UFR SMBH, 93140 Bobigny, France
| | - J Boujenah
- Service de gynécologie-obstétrique, université Paris XIII-Bobigny, CHU Jean-Verdier, avenue du 14-Juillet, 93140 Bondy, France; Université Paris 13, Sorbonne Paris cité, UFR SMBH, 93140 Bobigny, France.
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Marret H. [Off-label use--or science before the law]. GYNECOLOGIE, OBSTETRIQUE & FERTILITE 2015; 43:417-418. [PMID: 26004025 DOI: 10.1016/j.gyobfe.2015.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Indexed: 06/04/2023]
Affiliation(s)
- H Marret
- Service de gynécologie, pôle de gynécologie, obstétrique, médecine fœtale et reproduction humaine, hôpital Bretonneau, CHU Bretonneau, 2, boulevard Tonnellé, 37044 Tours cedex 1, France.
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