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Mori KH, Tavares BV, Yela DA, Baccaro LFC, Juliato CRT. Experience of a Tertiary Service in the Treatment of Women with Cervical Pregnancy. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRICIA : REVISTA DA FEDERACAO BRASILEIRA DAS SOCIEDADES DE GINECOLOGIA E OBSTETRICIA 2022; 44:1014-1020. [PMID: 36580946 PMCID: PMC9800062 DOI: 10.1055/s-0042-1757954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Cervical pregnancy is challenging for the medical community, as it is potentially fatal. The treatment can be medical or surgical; however, there are no protocols that establish the best option for each case. The objective of the present study was to describe the cases of cervical pregnancy admitted to a tertiary university hospital over a period of 18 years. METHODS A retrospective study based on a review of the medical records of all cervical pregnancies admitted to the Women's Hospital at Universidade Estadual de Campinas, Southeastern Brazil, from 2000 to 2018. RESULTS We identified 13 cases of cervical pregnancy out of a total of 673 ectopic pregnancies; only 1 case was initially treated with surgery because of hemodynamic instability. Of the 12 cases treated conservatively, 7 were treated with single-dose intramuscular methotrexate, 1, with intravenous and intramuscular methotrexate, 1, with intravenous methotrexate, 1, with 2 doses of intramuscular methotrexate, and 2, with intra-amniotic methotrexate. Of these cases, one had a therapeutic failure that required a hysterectomy. Two women received blood transfusions. Four women required cervical tamponade with a Foley catheter balloon for hemostasis. There was no fatal outcome. CONCLUSION Cervical pregnancy is a rare and challenging condition from diagnosis to treatment. Conservative treatment was the primary method of therapy used, with satisfactory results. In cases of increased bleeding, cervical curettage was the initial treatment, and it was associated with the use of a cervical balloon for hemostasis.
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Affiliation(s)
| | | | | | | | - Cassia Raquel Teatin Juliato
- Universidade Estadual de Campinas, Campinas, SP, Brazil,Address for correspondence Cássia Raquel Teatin Juliato Rua Alexander Fleming, 101, Cidade Universitária Zeferino Vaz, Campinas, SP, 13083-881Brazil
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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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Drever N, Bertolone J, Shawki M, Janssens S. Caesarean scar ectopic pregnancy: Experience from an Australian tertiary centre. Aust N Z J Obstet Gynaecol 2020; 60:330-335. [PMID: 31944267 DOI: 10.1111/ajo.13119] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 11/23/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Despite the rising incidence of caesarean scar pregnancy (CSP), as yet there are no consensus or evidence-based guidelines for management. AIMS To review diagnosis, treatment and management of all women with CSP over a 5 year period at Mater Mothers' Hospital, Brisbane, Australia. MATERIALS AND METHODS Retrospective cohort study of CSP between 2013-2018. Data reviewed included demographics, presenting symptoms, gestational age, ultrasound findings, human chorionic gonadotrophin levels, treatment success, complications, and if available, subsequent pregnancy outcomes. RESULTS Twenty-eight women were treated for CSP during the study period. Initial diagnosis was delayed in ten (36%). Overall success rates of initial treatment were 22/28 (79%). Of the six cases of failed treatment, five had been treated with systemic methotrexate alone. All women requiring further intervention had fetal pole present, and 50% had fetal cardiac activity. Failure rate of systemic methotrexate alone was 5/11 (45%). Eleven women deemed appropriate for conservative management did not require further treatment or experience complications. Nine women had data available for subsequent pregnancies, of whom two developed placenta accreta. CONCLUSION This study provides data that may assist in guideline development and decision-making for management of CSP. Conservative management in carefully selected women appeared to be safe. Nearly half of women treated with systemic methotrexate alone required another treatment modality, suggesting a role for intralesional treatment, particularly in the presence of fetal pole ± fetal cardiac activity. More than one in five women with documented subsequent pregnancies were diagnosed with placenta accreta.
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Affiliation(s)
- Natalie Drever
- Department of Obstetrics and Gynaecology, Mater Mothers' Hospital, Brisbane, Queensland, Australia
| | - Julia Bertolone
- Early Pregnancy Assessment Unit, Mater Mother's Hospital, Brisbane, Queensland, Australia
| | - Marwan Shawki
- Department of Obstetrics and Gynaecology, Mater Mothers' Hospital, Brisbane, Queensland, Australia
| | - Sarah Janssens
- Department of Obstetrics and Gynaecology, Mater Mothers' Hospital, Brisbane, Queensland, Australia.,Mater Education, Mater Hospital, Brisbane, Queensland, Australia
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Significant increase in serum hCG levels following methotrexate therapy is associated with lower treatment success rates in ectopic pregnancy patients. Eur J Obstet Gynecol Reprod Biol 2018; 231:188-191. [DOI: 10.1016/j.ejogrb.2018.10.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 10/23/2018] [Accepted: 10/24/2018] [Indexed: 11/23/2022]
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Odejinmi F, Huff KO, Oliver R. Individualisation of intervention for tubal ectopic pregnancy: historical perspectives and the modern evidence based management of ectopic pregnancy. Eur J Obstet Gynecol Reprod Biol 2016; 210:69-75. [PMID: 27940397 DOI: 10.1016/j.ejogrb.2016.10.037] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 10/21/2016] [Indexed: 11/30/2022]
Abstract
Historically, ectopic pregnancy was a life-threatening condition where diagnosis was possible only at post mortem or laparotomy and maternal mortality was up to 90%. The evolution in the management of ectopic pregnancy has meant that diagnosis can be made using non-invasive techniques with an aim to identify the ectopic gestation before tubal rupture. This enables health care professionals to offer management options that consider not only maternal mortality, but morbidity and fertility outcomes as well. In spite of this, diagnostic techniques and management options are not without limitations. Research is currently focused on new tests with a single diagnostic capability, diagnostic and treatment algorithms and safe methods of triaging patients. This article aims to review the current literature on the diagnosis and management of ectopic pregnancy and to formulate a pathway to help individualise care and achieve the best possible outcome.
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Affiliation(s)
- Funlayo Odejinmi
- Whipps Cross University Hospital, Barts Health NHS Trust, London, E11 1NR, UK.
| | - Keren O Huff
- Whipps Cross University Hospital, Barts Health NHS Trust, London, E11 1NR, UK
| | - Reeba Oliver
- Whipps Cross University Hospital, Barts Health NHS Trust, London, E11 1NR, UK
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Desai A, Fleischer AC, Wahab SA, New M, Smolinsky C, McKenna J, Andreotti R. Sonography of Responsive Versus Nonresponsive Ectopic Pregnancies. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:1341-1347. [PMID: 27208202 DOI: 10.7863/ultra.15.04008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 08/28/2015] [Indexed: 06/05/2023]
Abstract
This case series describes changes in size, vascularity, and cul-de-sac fluid in 30 patients with ectopic pregnancies who were treated with systemic methotrexate. Pretreatment and posttreatment transvaginal sonography of the ectopic pregnancies was performed with color Doppler imaging, and the images were assessed for changes in size, vascularity, and cul-de-sac free fluid. There was a trend for nonresponders to show increased vascularity on serial examinations, although this finding was also seen in a single responder. There was also a trend for nonresponders with increased vascularity to be associated with a greater increase in β-human chorionic gonadotropin levels and responders with decreased vascularity to be associated with a greater decrease in β-human chorionic gonadotropin levels.
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Affiliation(s)
- Aditi Desai
- Department of Radiology, Nashville, Tennessee USA
| | - Arthur C Fleischer
- Department of Radiology, Nashville, Tennessee USADepartment of Obstetrics and Gynecology, Nashville, Tennessee USA
| | - Shaun A Wahab
- Department of Radiology, University of Cincinnati Medical Center, Cincinnati, Ohio USA
| | - Melinda New
- Department of Obstetrics and Gynecology, Nashville, Tennessee USA
| | | | - John McKenna
- Vanderbilt University Medical Center, Nashville, Tennessee USA
| | - Rochelle Andreotti
- Department of Radiology, Nashville, Tennessee USADepartments of Obstetrics and Gynecology, Nashville, Tennessee USA
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Lattouf I, Lu C, Pixton S, Reid S, Condous G. Is there a difference in the behaviour and subsequent management of ectopic pregnancies seen at first scan compared to those ectopic pregnancies which commence as pregnancies of unknown location? Aust N Z J Obstet Gynaecol 2016; 56:107-12. [PMID: 26817526 DOI: 10.1111/ajo.12434] [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: 12/16/2014] [Accepted: 11/26/2015] [Indexed: 11/30/2022]
Abstract
AIMS The primary aim was to assess whether ectopic pregnancies (EPs) visualised on primary scan behave differently to EPs initially characterised as pregnancies of unknown location (PUL). The secondary aim was to assess whether the EP group is more likely to have surgical management compared to the PUL ectopic pregnancy group. MATERIALS AND METHODS Prospective observational study. Consecutive first trimester women presenting from November 2006 to March 2012 underwent transvaginal ultrasound (TVS). Women diagnosed with an EP on TVS were divided into two groups: visualised EPs noted on the first TVS, and PULs which subsequently developed into EPs. Twenty-five historical, clinical, biochemical and ultrasonographic variables were collected. Different management strategies (expectant, medical, surgical) once an EP was confirmed on TVS were recorded. Univariate analysis was performed to compare differences between the two groups as well as rates for the three final management strategies. RESULTS A total of 3341 consecutive women underwent TVS. On initial scan, 86.2% were classified as intrauterine pregnancy, 8.8% as PUL and 5.0% as EP (145 tubal/23 nontubal EPs). There were 194 tubal EPs in final analysis: 49 of 194 (25.3%) initially classified as PUL and 145 of 194 (74.7%) diagnosed as EP at primary TVS. When comparing the EP to the PUL EP group, the pain scores were 3.34 versus 1.91 (P-value < 0.001), the mean sac diameters were 35.2 versus 18.5 mm (P-value = 0.0327), and the volume of the EP masses were 8.21E+04 versus 1.40E+04 (P-value = 0.0341). Cumulative surgical intervention rate was significantly higher in EP compared to PUL EP group (P-value = 0.036). CONCLUSIONS EPs seen at the first ultrasound scan appear to be more symptomatic, larger in diameter and volume compared to EPs which started as PULs. Cumulative surgical intervention rate was noted to be higher in this group with EP seen on ultrasound at the outset.
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Affiliation(s)
- Ihab Lattouf
- Early Pregnancy, Acute Gynaecology & Advanced Endosurgery Unit, Sydney Medical School Nepean, Nepean Hospital, University of Sydney, Penrith, New South Wales, Australia
| | - Chuan Lu
- Department of Computer Science, Aberystwyth University, Aberystwyth, UK
| | - Sarah Pixton
- Early Pregnancy, Acute Gynaecology & Advanced Endosurgery Unit, Sydney Medical School Nepean, Nepean Hospital, University of Sydney, Penrith, New South Wales, Australia
| | - Shannon Reid
- Early Pregnancy, Acute Gynaecology & Advanced Endosurgery Unit, Sydney Medical School Nepean, Nepean Hospital, University of Sydney, Penrith, New South Wales, Australia
| | - George Condous
- Early Pregnancy, Acute Gynaecology & Advanced Endosurgery Unit, Sydney Medical School Nepean, Nepean Hospital, University of Sydney, Penrith, New South Wales, Australia
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Bodur S, Özdamar Ö, Kılıç S, Gün İ. The efficacy of the systemic methotrexate treatment in caesarean scar ectopic pregnancy: A quantitative review of English literature. J OBSTET GYNAECOL 2014; 35:290-6. [DOI: 10.3109/01443615.2014.954101] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Orozco EM, Sánchez-Durán MA, Bello-Muñoz JC, Sagalá J, Carreras E, Roura LC. ß-hCG and prediction of therapeutic success in ectopic pregnancies treated with methotrexate, results from a prospective observational study. J Matern Fetal Neonatal Med 2014; 28:695-9. [PMID: 24871360 DOI: 10.3109/14767058.2014.928857] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To evaluate the diagnostic accuracy of different beta-human chorionic gonadotrophin (ß-hCG) levels measurement, for predicting success of medical treatment in cases diagnosed as tubal ectopic pregnancy (TEP). DESIGN Five-year prospective observational study. SETTING Prenatal Diagnosis Unit, Vall d'Hebron University Hospital - Barcelona. PATIENTS TEP cases fulfilling criteria for medical treatment with Methotrexate. INTERVENTIONS ß-hCG levels were measured on d 0, 4 and 7 of treatment. Results were compared by non-parametrical tests. A ROC curve was plotted to define cut-off points. Diagnostic accuracy of the different measurements was evaluated. MAIN OUTCOME MEASURE Failure of treatment defined as need for surgical treatment or persistence of high ß-HCG levels despite treatment. RESULTS 126 women were diagnosed as TEP, eligible for medical treatment. There were no differences in parity, age, previous TEP, or adnexal mass size. Success rate was 88%. ß-HCG decreased significantly more, between days 0-7 and 4-7, in the successful cases. LR for success prediction was 6.2 and 7.8 for ß-HCG levels at days 4 and 7 respectively, 4.02 and 2.47 for decrement between days 0-7 (25%) and 4-7 (20%), respectively. CONCLUSION ß-hCG cutoff values have a potential for predicting a successful medical treatment of TEP.
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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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Celik E, Türkçüoğlu I, Karaer A, Kırıcı P, Eraslan S. Assessment of early decline in the percentage of β-hCG values between days 0 and 4 after methotrexate therapy in ectopic pregnancy for the prediction of treatment success. J Turk Ger Gynecol Assoc 2013; 14:125-9. [PMID: 24592090 DOI: 10.5152/jtgga.2013.50133] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 05/26/2013] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate percentage changes in serum beta-human chorionic gonadotropin (β-hCG) values between days 0-1, 0-4 and 0-7 as an indicator of methotrexate therapy success in extra-uterine pregnancies. MATERIAL AND METHODS Women with ectopic pregnancy treated with single-dose methotrexate therapy between January 2011 and August 2012 were assessed. Recorded data were reviewed electronically from patient files. All women (n=93) with an ectopic pregnancy treated medically with intramuscular methotrexate (50 mg/m(2)) were included. The percentage changes in serum β-hCG levels from day 0 to 1, day 0 to 4 and day 0 to 7 were calculated for each case. RESULTS The median β-hCG values decreased between days 0 and 4 by 55.8%, and 89.6% of these cases were treatment successes. The median initial serum β-hCG values were lower in women with successful treatment, but this was not statistically significant (p=0.11). CONCLUSION A decline in serum β-hCG values between days 0 and 4 appears to be the best predictor. It would be beneficial to determine whether a woman with an ectopic pregnancy treated with single-dose methotrexate administration will be treated successfully.
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Affiliation(s)
- Ebru Celik
- Department of Obstetrics and Gynecology, İnönü University Faculty of Medicine, Malatya, Turkey
| | - Ilgın Türkçüoğlu
- Department of Obstetrics and Gynecology, İnönü University Faculty of Medicine, Malatya, Turkey
| | - Abdullah Karaer
- Department of Obstetrics and Gynecology, İnönü University Faculty of Medicine, Malatya, Turkey
| | - Pinar Kırıcı
- Department of Obstetrics and Gynecology, İnönü University Faculty of Medicine, Malatya, Turkey
| | - Sevil Eraslan
- Department of Obstetrics and Gynecology, İnönü University Faculty of Medicine, Malatya, Turkey
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Ustunyurt E, Duran M, Coskun E, Ustunyurt ÖB, Simşek H. Role of initial and day 4 human chorionic gonadotropin levels in predicting the outcome of single-dose methotrexate treatment in women with tubal ectopic pregnancy. Arch Gynecol Obstet 2013; 288:1149-52. [PMID: 23666603 DOI: 10.1007/s00404-013-2879-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 05/02/2013] [Indexed: 11/27/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the initial and day 4 beta-human chorionic gonadotropin (β-hCG) levels as a predictor of methotrexate (MTX) therapy success for ectopic pregnancy. METHODS Retrospective study of 87 patients with tubal ectopic pregnancy treated with a single dose of 50 mg/m(2) MTX at Bursa Şevket Yılmaz Research and Education Hospital between January 2011 and July 2012 was performed. RESULTS The overall success rate is measured as 72.4 %. The two groups of patients, successfully treated patients (n = 63) and unsuccessfully treated patients (n = 24), were compared. The mean initial β-hCG level was significantly lower in the treatment success group than in the treatment failure group (1,417 mIU/mL versus 5,995 mIU/mL, p < 0.001). The number of cases with decreasing β-hCG level on day 4 was significantly more in the success group compared to the failure group (61.9 and 37.5 %, respectively, p = 0.04). The success rate was 90 % when β-hCG levels were <1,000 mIU/mL, 85.7 % when the levels were between 1,000 and 1,999 mIU/mL, and 76.5 % when the levels were between 2,000 and 2,999 mIU/mL, 54.5 % when the levels were between 3,000 and 3,999 mIU/mL. CONCLUSION Single-dose MTX therapy is a safe and effective treatment modality for tubal ectopic pregnancies with the β-hCG serum concentration below 3,000 mIU/mL, and β-hCG level changes between days 0 and 4 after MTX therapy are important in predicting the outcome of treatment.
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Affiliation(s)
- Emın Ustunyurt
- The Department of Obstetrics and Gynecology, Bursa Şevket Yılmaz Research and Education Hospital, Bursa, Turkey,
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Szylit NA, Podgaec S, Traina E, Oliveira RDCS. Video laparoscopic intervention for an interstitial pregnancy after failure of clinical treatment. SAO PAULO MED J 2012; 130:202-7. [PMID: 22790554 PMCID: PMC10876192 DOI: 10.1590/s1516-31802012000300011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Revised: 01/05/2011] [Accepted: 07/11/2011] [Indexed: 11/22/2022] Open
Abstract
CONTEXT Interstitial pregnancy is a rare form of ectopic pregnancy for which the best therapeutic course of action has yet to be determined. Surgical intervention entails a high risk of hemorrhage due to the great vascularization of the cornual region of the uterus. Case descriptions facilitate the analysis of results and aid clinicians in determining the most appropriate course of action in these situations. CASE REPORT In a patient with an ultrasound diagnosis of interstitial pregnancy, clinical treatment using methotrexate was chosen. However, after one week, there was a marked decline in the serum level of the β subunit of chorionic gonadotropin hormone, although an ultrasound examination revealed embryonic cardiac activity. A second dose of the chemotherapy was administered. Embryonic cardiac activity persisted 48 hours later. Video laparoscopy was performed to achieve right-side cornual resection, which resulted in satisfactory resolution of the case.
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Affiliation(s)
- Nilson Abrão Szylit
- Birth Control Outpatient Clinic, Instituto Israelita de Responsabilidade Social Albert Einstein, São Paulo, Brazil.
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Thabet A, Kalva SP, Liu B, Mueller PR, Lee SI. Interventional Radiology in Pregnancy Complications: Indications, Technique, and Methods for Minimizing Radiation Exposure. Radiographics 2012; 32:255-74. [DOI: 10.1148/rg.321115064] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Transabdominal ultrasound-guided intra-gestational sac single dose MTX injection in a tubal pregnancy. Taiwan J Obstet Gynecol 2011; 49:536-8. [PMID: 21199765 DOI: 10.1016/s1028-4559(10)60115-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2010] [Indexed: 11/21/2022] Open
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Balci O, Ozdemir S, Mahmoud AS, Acar A, Colakoglu MC. The efficacy of multiple-dose methotrexate treatment for unruptured tubal ectopic pregnancy and conversion rate to surgery: a study on 294 cases. Fertil Steril 2010; 93:2415-7. [PMID: 20137786 DOI: 10.1016/j.fertnstert.2009.09.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2009] [Revised: 08/11/2009] [Accepted: 09/08/2009] [Indexed: 10/19/2022]
Abstract
In this prospective study 294 patients diagnosed with ectopic pregnancy (EP) were treated with multiple-dose methotrexate (MTX) to determine the conversion rate to surgery. We concluded that multiple-dose MTX treatment had a low success rate, and the success rate was not related to initial b-hCG value; it was more related to the size of gestational mass before treatment.
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Affiliation(s)
- Osman Balci
- Department of Obstetrics and Gynecology, Meram Medicine Faculty, Selcuk University, Akyokus, 42080, Konya, Turkey.
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Cutoff value of human chorionic gonadotropin in relation to the number of methotrexate cycles in the successful treatment of ectopic pregnancy. Fertil Steril 2009; 92:1203-1207. [DOI: 10.1016/j.fertnstert.2008.07.1775] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2008] [Revised: 05/05/2008] [Accepted: 07/29/2008] [Indexed: 11/23/2022]
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Kirk E, Bourne T. Diagnosis of ectopic pregnancy with ultrasound. Best Pract Res Clin Obstet Gynaecol 2009; 23:501-8. [PMID: 19356985 DOI: 10.1016/j.bpobgyn.2008.12.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2008] [Accepted: 12/15/2008] [Indexed: 01/10/2023]
Abstract
Transvaginal sonography (TVS) is now the imaging modality of choice for the diagnosis of ectopic pregnancy with overall reported sensitivities of>90%. Specific sonographic criteria exist for the diagnosis of tubal and non-tubal pregnancies including cervical and caesarean section scar pregnancies. Diagnosis is based on the visualization of an ectopic mass rather than the inability to visualize an intra-uterine pregnancy. This chapter discusses the specific criteria used for the diagnosis of ectopic pregnancy and examines the literature assessing the accuracy of ultrasound as a diagnostic tool.
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Affiliation(s)
- Emma Kirk
- Whittington Hospital, Magdala Avenue, London, UK.
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Valsky DV, Yagel S. Ectopic pregnancies of unusual location: management dilemmas. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2008; 31:245-251. [PMID: 18307196 DOI: 10.1002/uog.5277] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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