1
|
Kłobuszewski B, Szmygin M, Nieoczym K, Kłobuszewska O, Woźniak S, Pyra KK. Advances in Treating Cesarean Scar Pregnancy: A Comprehensive Review of Techniques, Clinical Outcomes, and Fertility Preservation. Med Sci Monit 2024; 30:e943550. [PMID: 38566372 PMCID: PMC11000526 DOI: 10.12659/msm.943550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 02/01/2024] [Indexed: 04/04/2024] Open
Abstract
Cesarean scar pregnancy (CSP) is a rare but potentially dangerous condition that occurs when an embryo implants and develops within the scar tissue from a previous cesarean section. Treatment of cesarean scar pregnancy depends on several factors, including the gestational age of the pregnancy, the presence of complications, and the individual patient's circumstances. We performed a systematic review of the published literature on management of cesarean scar pregnancy and the outcomes, complications, and effects on fertility. A systematic review of recent scientific literature published up to April 2023 in the databases PubMed, Google Scholar, and Web of Science was performed according to the PRISMA guidelines. We used the search keywords "cesarean scar pregnancy," "methotrexate," "systemic," "chemoembolization," and "uterine artery embolization." The baseline search resulted in 413 articles. After the exclusion of 342 irrelevant articles, the abstracts and titles of the remaining 71 articles were read for potential inclusion, resulting in exclusion of a further 16 articles. Therefore, the full texts of 55 articles were investigated. Finally, 42 papers were included in the study. The main finding was that chemoembolization is more successful than systemic methotrexate therapy, and is associated with less blood loss and shorter hospital stay. Transarterial chemoembolization appears to be safe and effective method of treatment in patients with CSP and should thus be considered during multidisciplinary evaluation of these patients.
Collapse
Affiliation(s)
- Bartosz Kłobuszewski
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Maciej Szmygin
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
- Department of Human Anatomy, Medical University of Lublin, Lublin, Poland
| | - Karolina Nieoczym
- Student Scientific Society at the Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Olga Kłobuszewska
- Department of Pediatric Radiology, University Pediatric Hospital, Lublin, Poland
| | - Sławomir Woźniak
- Department of Gynecology, Medical University of Lublin, Lublin, Poland
| | - Krzysztof Konrad Pyra
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| |
Collapse
|
2
|
Cutting E, Horta F, Dang V, van Rumste MM, Mol BWJ. Intracytoplasmic sperm injection versus conventional in vitro fertilisation in couples with males presenting with normal total sperm count and motility. Cochrane Database Syst Rev 2023; 8:CD001301. [PMID: 37581383 PMCID: PMC10426261 DOI: 10.1002/14651858.cd001301.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Abstract
BACKGROUND Starting over 40 years ago, in vitro fertilisation (IVF) has become the cornerstone for fertility treatment. Since then, in 1992, Palermo and colleagues successfully applied the technique intracytoplasmic sperm injection (ICSI) to benefit couples where conventional in vitro fertilisation (c-IVF) and sub-zonal insemination (SUZI) proved unsuccessful. After this case report, ICSI has become the treatment of choice for couples with severe male factor subfertility. Over time, ICSI has been used in the treatment of couples with mild male and even unexplained infertility. This review is an update of the review, first published in 1999, comparing ICSI with c-IVF for couples with males presenting with normal total sperm count and motility. OBJECTIVES To evaluate the effectiveness and safety of ICSI relative to c-IVF in couples with males presenting with normal total sperm count and motility. SEARCH METHODS We searched the following databases and trial registers: Cochrane Central Register of Controlled Trials (CENTRAL), Embase (excerpta Medica Database), MEDLINE (Medical Literature Analysis and Retrieval System Online) and PsycINFO (Psychological literature database) for articles between January 2010 and 22 February 2023. SELECTION CRITERIA We included randomised controlled trials (RCTs) that compared ICSI with c-IVF in couples with males presenting with normal total sperm count and motility. DATA COLLECTION AND ANALYSIS We used standard methodical procedures recommended by Cochrane. The primary review outcomes were live birth and adverse events. Secondary outcomes included clinical pregnancy, viable intrauterine pregnancy and miscarriage. MAIN RESULTS The original review published in 2003 included one RCT. In this 2023 update, we identified an additional two RCTs totalling a cohort of 1539 couples, comparing ICSI with c-IVF techniques. Two studies reported on live birth. Using the GRADE method, we assessed the certainty of evidence and reported evidence as low-certainty for live birth. We are uncertain of the effect of ICSI versus c-IVF for live birth rates (risk ratio (RR) 1.11, 95% confidence interval (CI 0.94 to 1.30, I2 = 0%, 2 studies, n = 1124, low-certainty evidence). The evidence suggests that if the chance of live birth following c-IVF is assumed to be 32%, the chance of live birth with ICSI would be between 30% and 41%. For adverse events; multiple pregnancy, ectopic pregnancy, pre-eclampsia and prematurity, there was probably little or no difference between the two techniques. No study reported the primary outcome stillbirth. For secondary outcomes, we are uncertain of the effect of ICSI versus c-IVF for clinical pregnancy rates (RR 1.00, 95% CI 0.88 to 1.13, I2 = 45%, 3 studies, n = 1539, low-certainty evidence). Comparison of viable intrauterine pregnancy rates showed probably little or no difference between ICSI and c-IVF (RR 1.00, 95% CI 0.86 to 1.16, I2=75%, 2 studies, n = 1479 couples, moderate-certainty evidence). The high heterogeneity may have been caused by one older study conducted when protocols were less rigorous. The evidence suggests that if the chance of viable intrauterine pregnancy following c-IVF is assumed to be 33%, the chance of viable intrauterine pregnancy with ICSI would be between 28% and 38%. Miscarriage rates also showed probably little or no difference between the two techniques. AUTHORS' CONCLUSIONS The current available studies that compare ICSI and c-IVF in couples with males presenting with normal total sperm count and motility, show neither method was superior to the other, in achieving live birth, adverse events (multiple pregnancy, ectopic pregnancy, pre-eclampsia and prematurity), also alongside secondary outcomes, clinical pregnancy, viable intrauterine pregnancy or miscarriage.
Collapse
Affiliation(s)
- Elizabeth Cutting
- Department of Obstetrics and Gynaecology, School of Clinical Science, Monash University, Melbourne, Australia
| | - Fabrizzio Horta
- Department of Obstetrics and Gynaecology, School of Clinical Science, Monash University, Melbourne, Australia
- City Fertility, Notting Hill, Australia
- Monash Data Futures Institute, Monash University, Clayton, Australia
| | - Vinh Dang
- HOPE Research Centre, My Duc Hospital, Ho Chi Minh, Vietnam
| | | | - Ben Willem J Mol
- Department of Obstetrics and Gynaecology, School of Clinical Science, Monash University, Melbourne, Australia
- Aberdeen Centre for Women's Health Research, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| |
Collapse
|
3
|
Młodawski J, Kardas-Jarząbek A, Młodawska M, Świercz G. Conservative Management of Heterotopic Pregnancy: A Case Report and Review of Literature. Am J Case Rep 2023; 24:e940111. [PMID: 37550961 PMCID: PMC10421752 DOI: 10.12659/ajcr.940111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 07/06/2023] [Accepted: 06/07/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND Tubal heterotopic pregnancy is an extremely rare complication of pregnancy, in which there is a simultaneous presence of a pregnancy in the uterine cavity and in an ectopic location, most commonly in the fallopian tube. The management of such cases is not clearly established. In the case of a desire to maintain an intrauterine pregnancy, the surgical procedure consisting of a salpingectomy or salpingostomy is the most common. Such a procedure is effective, but it involves potential complications typical of surgeries, so, in some cases, it seems reasonable to apply the expectant management. CASE REPORT A 31-year-old woman was admitted to the clinic due to pain in the right lower abdomen. An ultrasound examination revealed a gestational sac in the uterine cavity corresponding to 5 weeks of pregnancy with a yolk sac. A twin sac was found in the right fallopian tube. Due to the patient's mild symptoms, absence of bleeding into the peritoneal cavity, concerns about the safety of the embryo and the pregnant woman in case of surgery, conservative management was decided. On the 20th day, the patient was discharged from the clinic with a viable intrauterine pregnancy and a partially absorbed ectopic pregnancy. CONCLUSIONS In the case of an ectopic tubal pregnancy, if there are no symptoms of bleeding into the peritoneal cavity, it is possible to adopt a safe conservative approach with strict patient observation.
Collapse
Affiliation(s)
- Jakub Młodawski
- Collegium Medicum, Jan Kochanowski University in Kielce, Kielce, Poland
| | | | - Marta Młodawska
- Collegium Medicum, Jan Kochanowski University in Kielce, Kielce, Poland
| | - Grzegorz Świercz
- Collegium Medicum, Jan Kochanowski University in Kielce, Kielce, Poland
| |
Collapse
|
4
|
Poxon A, Clarfield L, Cherniak R, Page A, Po L. Delays to Surgery in Emergency Department Cases of Ectopic Pregnancy: A Quality Improvement Study. J Obstet Gynaecol Can 2023; 45:21-26. [PMID: 36436806 DOI: 10.1016/j.jogc.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/02/2022] [Accepted: 11/03/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Create a process map for emergency department (ED) presentations of surgical ectopic pregnancy, and identify areas of management amenable to quality improvement. METHODS A retrospective chart review of all patients undergoing surgical management of ectopic pregnancy at a large, urban, academic tertiary care centre from 2015 to 2017 was performed. RESULTS Seventy-three patients were included. There were 6 (8.2%) unstable A cases (recommended time to operating room [OR] 0-2 hours), 23 (31.5%) stable A cases, and 44 (60%) B cases (recommended time to OR 2-8 hours). The percent of patients who were in the OR within the recommended time window were 6 (100%) for unstable A cases, 13 (56%) stable A cases, and 29 (65.9%) stable B cases, respectively (P = 0.139). Notable time delays include the time from gynaecology referral to the time seen by gynaecology (29.7% of total wait time for stable A cases from ED to OR) and the time the OR was booked to the time the patient was brought to the OR (53.2% of total wait time for stable B cases). Of the patients seen by physician at the emergency department first, the time from triage to the OR was significantly shorter for patients that received bedside ultrasound only (0.67 ± 0.5 hours vs. 2.1 ± 1.8 hours [P = 0.007]). CONCLUSION This is the first study to map the ED presentation of surgical ectopic pregnancy. The management of ectopic pregnancy would benefit from the development of surgical triage decision aids, a surgical care pathway, and increased use of screening bedside ultrasound.
Collapse
Affiliation(s)
- Amanda Poxon
- Temerty School of Medicine, University of Toronto, Toronto, ON.
| | - Lauren Clarfield
- Department of Obstetrics and Gynaecology at the University of Toronto, Toronto, ON
| | - Rebecca Cherniak
- Department of Obstetrics and Gynaecology at the University of Toronto, Toronto, ON
| | - Andrea Page
- Department of Obstetrics and Gynaecology at the University of Toronto, Toronto, ON; DAN Women and Babies Program at Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON
| | - Leslie Po
- Department of Obstetrics and Gynaecology at the University of Toronto, Toronto, ON; Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON
| |
Collapse
|
5
|
Platts S, Ranawaka J, Oliver R, Patra-Das S, Kotabagi P, Neophytou C, Shah N, Toal M, Bassett P, Davison A, Gbegbaje M, Rao K, Rouabhi S, Watson S, Odejinmi F. Impact of severe acute respiratory syndrome coronavirus 2 on ectopic pregnancy management in the United Kingdom: a multicentre observational study. BJOG 2021; 128:1625-1634. [PMID: 33998125 PMCID: PMC8209857 DOI: 10.1111/1471-0528.16756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2021] [Indexed: 12/30/2022]
Abstract
Objective To describe the impact of coronavirus disease 2019 (COVID‐19) on the management of women with ectopic pregnancy. Design A multicentre observational study comparing outcomes from a prospective cohort during the pandemic [COVID‐19‐ectopic pregnancy registry (CEPR)] compared with a historical pre‐pandemic cohort [non‐COVID‐19‐ectopic pregnancy registry (NCEPR)]. Setting Five London university hospitals. Population and methods Consecutive patients diagnosed clinically and/or radiologically with ectopic pregnancy (March 2020–August 2020) were entered into the CEPR and results were compared with the NCEPR cohort (January 2019–June 2019). An adjusted analysis was performed for potentially confounding variables. Main outcome measures Patient demographics, management (expectant, medical and surgical), length of treatment, number of hospital visits (non‐surgical management), length of stay (surgical management) and 30‐day complications. Results Three hundred and forty‐one women met the inclusion criteria: 162 CEPR and 179 NCEPR. A significantly lower percentage of women underwent surgical management versus non‐surgical management in the CEPR versus NCEPR (58.6%; 95/162 versus 72.6%; 130/179; P = 0.007). Among patients managed with expectant management, the CEPR had a significantly lower mean number of hospital visits compared with NCEPR (3.0, interquartile range [IQR] [3, 5] versus 9.0, [5, 14]; P = <0.001). Among patients managed with medical management, the CEPR had a significantly lower median number of hospital visits versus NCEPR (6.0, [5, 8] versus 9, [6, 10]; P = 0.003). There was no observed difference in complication rates between cohorts. Conclusion Women were found to undergo significantly higher rates of non‐surgical management during the COVID‐19 first wave compared with a pre‐pandemic cohort. Women managed non‐surgically in the CPER cohort were also managed with fewer hospital attendances. This did not lead to an increase in observed complication rates. Tweetable abstract A higher rate of non‐surgical management of ectopic pregnancy during the COVID‐19 pandemic did not increase complication rates. A higher rate of non‐surgical management of ectopic pregnancy during the COVID‐19 pandemic did not increase complication rates.
Collapse
Affiliation(s)
- S Platts
- Department of Obstetrics and Gynaecology, Whipps Cross University Hospital, Barts Health Trust, London, UK
| | - J Ranawaka
- Department of Obstetrics and Gynaecology, Whipps Cross University Hospital, Barts Health Trust, London, UK
| | - R Oliver
- Department of Obstetrics and Gynaecology, Whipps Cross University Hospital, Barts Health Trust, London, UK
| | - S Patra-Das
- Department of Obstetrics and Gynaecology, Homerton University Hospital, London, UK
| | - P Kotabagi
- Department of Obstetrics and Gynaecology, North Middlesex University Hospital, London, UK
| | - C Neophytou
- Department of Obstetrics and Gynaecology, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - N Shah
- Department of Obstetrics and Gynaecology, Newham Hospital, Barts Health NHS Trust, London, UK
| | - M Toal
- Department of Obstetrics and Gynaecology, Homerton University Hospital, London, UK
| | - P Bassett
- Statsconsultancy Ltd, Amersham, Buckinghamshire, UK
| | - A Davison
- Department of Obstetrics and Gynaecology, Homerton University Hospital, London, UK
| | - M Gbegbaje
- Department of Obstetrics and Gynaecology, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - K Rao
- Department of Obstetrics and Gynaecology, Newham Hospital, Barts Health NHS Trust, London, UK
| | - S Rouabhi
- Department of Obstetrics and Gynaecology, North Middlesex University Hospital, London, UK
| | - S Watson
- Department of Obstetrics and Gynaecology, Homerton University Hospital, London, UK
| | - F Odejinmi
- Department of Obstetrics and Gynaecology, Whipps Cross University Hospital, Barts Health Trust, London, UK
| |
Collapse
|
6
|
Po L, Thomas J, Mills K, Zakhari A, Tulandi T, Shuman M, Page A. Guideline No. 414: Management of Pregnancy of Unknown Location and Tubal and Nontubal Ectopic Pregnancies. J Obstet Gynaecol Can 2021; 43:614-630.e1. [PMID: 33453378 DOI: 10.1016/j.jogc.2021.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To provide an evidence-based algorithm to guide the diagnosis and management of pregnancy of unknown location and tubal and nontubal ectopic pregnancy. TARGET POPULATION All patients of reproductive age. BENEFITS, HARMS, AND COSTS The implementation of this guideline aims to benefit patients with positive β-human chorionic gonadotropin results and provide physicians with a standard algorithm for expectant, medical, and surgical treatment of pregnancy of unknown location and tubal pregnancy and nontubal ectopic pregnancies. EVIDENCE The following search terms were entered into PubMed/Medline and Cochrane in 2018: cesarean section, chorionic gonadotropin, beta subunit, human/blood, fallopian tubes/surgery, female, fertility, humans, infertility, laparoscopy, methotrexate, methotrexate/administration & dosage, methotrexate/therapeutic use, pregnancy (abdominal, angular, cervix, cornual, ectopic, ectopic/diagnosis, ectopic/diagnostic imaging, ectopic/drug therapy, ectopic/epidemiology, ectopic/mortality, ectopic/surgery, heterotopic, interstitial, isthmo-cervical, ovarian, tubal, unknown location), recurrence, risk factors, salpingectomy, salpingostomy, tubal pregnancy, ultrasonography, doppler ultrasonography, and prenatal. Articles included were randomized controlled trials, meta-analyses, systematic reviews, observational studies, and case reports. Additional publications were identified from the bibliographies of these articles. Only English-language articles were reviewed. VALIDATION METHODS The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and weak recommendations). INTENDED AUDIENCE Obstetrician-gynaecologists, family physicians, emergency physicians, midwives, registered nurses, nurse practitioners, medical students, and residents and fellows. SUMMARY STATEMENTS (GRADE RATINGS IN PARENTHESES) RECOMMENDATIONS (GRADE RATINGS IN PARENTHESES).
Collapse
|
7
|
Trindade VD, Burmann L, Viégas D, Hentschke MR, Azambuja R, Okada L, Petracco RG, Petracco A, Badalotti M, Michelon JDR. Ectopic pregnancy in left ovary and contralateral uterine tube diagnosed one week apart in In Vitro Fertilization with donor eggs: Case report. JBRA Assist Reprod 2019; 23:439-441. [PMID: 31294952 PMCID: PMC6798600 DOI: 10.5935/1518-0557.20190030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Bilateral ectopic pregnancy is a rare clinical condition with an estimated prevalence of 1/200 000 in spontaneous pregnancies. Studies have found that In Vitro Fertilization (IVF) is related to ectopic pregnancy independently, but the incidence of tubal disease in the donor egg recipient population is thought to be significantly lower than in the standard IVF population. We report the case of a patient participating in the egg-sharing program, who was diagnosed with ovarian ectopic pregnancy, treated with surgery. After one week, she was diagnosed with tubal ectopic pregnancy in the contralateral tube. The clinician should be aware that the treatment of one ectopic pregnancy does not preclude the occurrence of a second ectopic pregnancy in the same patient and should pay attention to the intra-operatory inspection of both side fallopian tubes in any ectopic pregnancy case. Routine ultrasound after ectopic pregnancy treatment may be reasonable, especially in high risk patients.
Collapse
Affiliation(s)
- Vanessa Devens Trindade
- Fertilitat - Centro de Medicina Reprodutiva, Porto Alegre, Rio Grande do Sul, Brasil.,Pontifícia Universidade Católica do Rio Grande do Sul. Porto Alegre, Rio Grande do Sul, Brasil
| | - Lauren Burmann
- Pontifícia Universidade Católica do Rio Grande do Sul. Porto Alegre, Rio Grande do Sul, Brasil
| | - Dieny Viégas
- Fertilitat - Centro de Medicina Reprodutiva, Porto Alegre, Rio Grande do Sul, Brasil
| | - Marta Ribeiro Hentschke
- Fertilitat - Centro de Medicina Reprodutiva, Porto Alegre, Rio Grande do Sul, Brasil.,Pontifícia Universidade Católica do Rio Grande do Sul. Porto Alegre, Rio Grande do Sul, Brasil
| | - Ricardo Azambuja
- Fertilitat - Centro de Medicina Reprodutiva, Porto Alegre, Rio Grande do Sul, Brasil
| | - Lilian Okada
- Fertilitat - Centro de Medicina Reprodutiva, Porto Alegre, Rio Grande do Sul, Brasil
| | - Rafaella Gehm Petracco
- Fertilitat - Centro de Medicina Reprodutiva, Porto Alegre, Rio Grande do Sul, Brasil.,Pontifícia Universidade Católica do Rio Grande do Sul. Porto Alegre, Rio Grande do Sul, Brasil
| | - Alvaro Petracco
- Fertilitat - Centro de Medicina Reprodutiva, Porto Alegre, Rio Grande do Sul, Brasil
| | - Mariangela Badalotti
- Fertilitat - Centro de Medicina Reprodutiva, Porto Alegre, Rio Grande do Sul, Brasil
| | - João da Rosa Michelon
- Fertilitat - Centro de Medicina Reprodutiva, Porto Alegre, Rio Grande do Sul, Brasil.,Pontifícia Universidade Católica do Rio Grande do Sul. Porto Alegre, Rio Grande do Sul, Brasil
| |
Collapse
|
8
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
Affiliation(s)
- Nilson Abrão Szylit
- Birth Control Outpatient Clinic, Instituto Israelita de Responsabilidade Social Albert Einstein, São Paulo, Brazil.
| | | | | | | |
Collapse
|
9
|
Abstract
The purpose of this study is to evaluate predictors of success of repeated injections of methotrexate in the single-dose regimen for the treatment of tubal ectopic pregnancy. All patients who had ectopic tubal pregnancy and were treated with a single dose regimen were retrospectively identified. 126 patients were treated with methotrexate. Among them, 39 patients were adequate for this study. 33 were treated with the 2nd dose and 27 were successfully cured. Additionally, 6 who were injected with the 3rd dose were all cured as well. Therefore, in our study, the success rate for the repeated injections of methotrexate was found to be 84.6% (33/39). The mean initial beta-hCG level was significantly lower in patients who were successfully treated than in patients who failed (3915.3+/-3281.3 vs. 8379.7+/-2604.4 IU/mL, p<0.05). The success rate is 96% when the beta-hCG level is less than 6,000 IU/mL and is 58% when beta-hCG is greater than 6,000 IU/mL (OR=18.57, 95% CI 1.86-185.89). The initial beta-hCG level is the only factor that has significant meaning as predictor of success of repeated injections of methotrexate in the single-dose regimen. Repeated injections of methotrexate may be particularly effective when the initial beta-hCG level is below 6,000 IU/mL.
Collapse
Affiliation(s)
- Geum Joon Cho
- Department of Obstetrics and Gynecology, College of Medicine, Korea University, Seoul, Korea
| | - Sang Hoon Lee
- Department of Obstetrics and Gynecology, College of Medicine, Korea University, Seoul, Korea
| | - Jin Woo Shin
- Department of Obstetrics and Gynecology, College of Medicine, Korea University, Seoul, Korea
| | - Nak Woo Lee
- Department of Obstetrics and Gynecology, College of Medicine, Korea University, Seoul, Korea
| | - Tak Kim
- Department of Obstetrics and Gynecology, College of Medicine, Korea University, Seoul, Korea
| | - Hai Joong Kim
- Department of Obstetrics and Gynecology, College of Medicine, Korea University, Seoul, Korea
| | - Kyu Wan Lee
- Department of Obstetrics and Gynecology, College of Medicine, Korea University, Seoul, Korea
| |
Collapse
|
10
|
Lee JK, Oh MJ, Shin JS, Lee KJ, Nam JH, Cha JH, Chang JD, Cho DH, Kang IS, Lee PI. Clinical effectiveness of urinary human chorionic gonadotropin related protein (hCGRP) quantification for diagnosis of ectopic pregnancy. J Korean Med Sci 2005; 20:461-7. [PMID: 15953870 PMCID: PMC2782204 DOI: 10.3346/jkms.2005.20.3.461] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
We detected pregnancy related new molecule, human chorionic gonadotropin related protein (hCGRP) in the urine of a pregnant women by using a monoclonal antibody against the human chorionic gonadotropin (hCG). This study examined the effectiveness of urinary hCGRP quantification in diagnosing ectopic pregnancy. This study included 40 normal pregnant women and 25 patients with ectopic pregnancy. Patients' serum and urinary intact whole hCG (i-hCG) and hCGRP concentrations were measured using sandwich ELISA and the ratio of hCGRP to i-hCG was calculated. Statistical analysis was performed using statistical package for social sciences (SPSS) 10.0. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the cut-off value to discriminate ectopic pregnancies from normal intrauterine pregnancies. Urinary hCGRP and hCGRP/i-hCG ratio in ectopic pregnancy group (14 +/- 6.6 ng/mL, 4.6 +/- 1.9%, respectively) were significantly lower than those of normal pregnancy group (149 +/- 10.2 ng/mL, 29.7 +/- 1.9%, respectively; p<0.001). Based on ROC curve analysis, a cut-off point of urinary hCGRP/i-hCG ratio <16.2% discriminated between ectopic pregnancy and normal pregnancy with a sensitivity, specificity, positive predictive value and negative predictive value of 92.0%, 90.0%, 32.6%, and 99.5%, respectively. Urinary hCGRP/i-hCG ratio measurement may be effective in diagnosing ectopic pregnancy.
Collapse
Affiliation(s)
- Jae-Kwan Lee
- Department of Obstetrics and Gynecology, Korea University School of Medicine, Seoul, Korea
| | - Min-Jeong Oh
- Department of Obstetrics and Gynecology, Korea University School of Medicine, Seoul, Korea
| | - Joong-Sik Shin
- Department of Obstetrics and Gynecology, Samsung Cheil Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung-Joo Lee
- Department of Obstetrics and Gynecology, College of Medicine Pochon CHA University, Seoul, Korea
| | - Jung-Hyun Nam
- Department of Obstetrics and Gynecology, Humasis Research Center, Gunpo, Korea
| | - Jung-Hak Cha
- Department of Obstetrics and Gynecology, Humasis Research Center, Gunpo, Korea
| | - Jin-Dong Chang
- Department of Obstetrics and Gynecology, Humasis Research Center, Gunpo, Korea
| | - Dong-Hee Cho
- Department of Obstetrics and Gynecology, Samsung Cheil Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - In-Soo Kang
- Department of Obstetrics and Gynecology, Samsung Cheil Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Paul I Lee
- Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA, USA
| |
Collapse
|
11
|
Kim TJ, Seong SJ, Lee KJ, Lee JH, Shin JS, Lim KT, Chung HW, Lee KH, Park IS, Shim JU, Park CT. Clinical outcomes of patients treated for cervical pregnancy with or without methotrexate. J Korean Med Sci 2004; 19:848-52. [PMID: 15608396 PMCID: PMC2816301 DOI: 10.3346/jkms.2004.19.6.848] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The objective of this study is to describe the clinical outcomes of patients treated for cervical pregnancy with or without methotrexate (MTX) and to evaluate the effects of MTX in the treatment of cervical pregnancy. Between January 1993 and February 2000, 31 patients were diagnosed with cervical pregnancy. Twenty-two patients were treated with MTX chemotherapy and nine patients were treated with surgical procedures without MTX treatment. In the non-MTX treatment group, three patients underwent total abdominal hysterectomy, five required adjuvant procedures to control the bleeding during dilatation and curettage (D&C) and only one patient was treated with a simple D&C. In the MTX treatment group, fourteen (63.6%) patients were treated with only MTX and eight (36.4%) cases underwent concomitant procedures (simple curettage, curettage and Foley catheter tamponade, cervical cerclage, ligation of the descending branches of uterine arteries, or ligation of hypogastric arteries). The uterus was preserved in all cases and three women delivered healthy babies in their subsequent pregnancy. In conclusion, early diagnosis, appropriate MTX regimen in combination of necessary adjuvant conservative procedures could contribute to successful treatment with preservation of the uterus and future reproductive ability.
Collapse
Affiliation(s)
- Tae Jin Kim
- Department of Obstetrics and Gynecology, Samsung Cheil Hospital and Women's Healthcare Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | - Seok Ju Seong
- Department of Obstetrics and Gynecology, Samsung Cheil Hospital and Women's Healthcare Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | - Keum Jung Lee
- Department of Obstetrics and Gynecology, Samsung Cheil Hospital and Women's Healthcare Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | - Je Hoon Lee
- Department of Obstetrics and Gynecology, Samsung Cheil Hospital and Women's Healthcare Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | - Joong Sik Shin
- Department of Obstetrics and Gynecology, Samsung Cheil Hospital and Women's Healthcare Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | - Kyung Taek Lim
- Department of Obstetrics and Gynecology, Samsung Cheil Hospital and Women's Healthcare Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | - Hwan Wook Chung
- Department of Obstetrics and Gynecology, Samsung Cheil Hospital and Women's Healthcare Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | - Ki Heon Lee
- Department of Obstetrics and Gynecology, Samsung Cheil Hospital and Women's Healthcare Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | - In Sou Park
- Department of Obstetrics and Gynecology, Samsung Cheil Hospital and Women's Healthcare Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | - Jae Uk Shim
- Department of Obstetrics and Gynecology, Samsung Cheil Hospital and Women's Healthcare Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | - Chong Taik Park
- Department of Obstetrics and Gynecology, Samsung Cheil Hospital and Women's Healthcare Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
| |
Collapse
|