Ectopic Pregnancy Mass Research Articles

Non-tubal ectopic pregnancy treatment experiences of a tertiary care center.

To evaluate the incidence, the risk factors, and the treatment outcomes of Non-tubal ectopic pregnancies (NTEP) treated in a tertiary care center. A total of 110 NTEP cases treated between 2014 and 2019 were included in the retrospective study. The study cohort was divided into 6 groups according to the pregnancy localization: 87 cesarean scar pregnancies (CSPs), 7 ovarian pregnancies, 6 interstitial pregnancies, 4 rudimentary horn pregnancies, 4 abdominal pregnancies, and 2 cervical pregnancies. One woman rejected all treatment modalities. Demographic characteristics, treatment modalities, and outcomes of each group were evaluated. In the study cohort, expectant management was performed in one (0.9%) woman. The methotrexate (MTX) treatment was administered in 29 (26.3%) women. Seventeen (15.4%) women underwent surgery, and 63 (57.2%) women underwent manual vacuum aspiration (MVA). A woman rejected all treatment modalities. Although 70.1% (n = 61) of CSPs were cured with MVA, 24.1% (n = 21) of them were treated with a single-dose MTX regimen in addition to MVA. The higher mean gestational sac size (33,9 ± 12,96mm vs. 17,34 ± 9,87mm), the higher mean gestational week (8,43 ± 1,16w vs. 6,66 ± 1,49w), the presence of fetal heartbeat (FHB) (90.5% vs. 26,2%) and the history of pelvic ınflammatory disease (PID) (38.1% vs. 6,6%) were found in the CSPs with MVA treatment failure (p < 0.05). The management of NTEPs should be individualized according to the clinical and ultrasonographic findings. The size of the ectopic pregnancy mass, the gestational week, the presence of FHB, and the PID history were the predictive factors for the failure of MVA in CSP cases.

Management of heterotopic pregnancy: clinical analysis of sixty-five cases from a single institution.

This retrospective study aims to analyze the influence of different treatment modalities on viable intrauterine pregnancy and to summarize the clinical features of heterotopic pregnancy (HP) patients. All patients diagnosed with HP between January 2012 and December 2022 in Tianjin Central Obstetrics and Gynecology Hospital were reviewed retrospectively. This study diagnosed 65 patients using transvaginal ultrasound (TVS), including two cases of natural pregnancy, seven cases of ovulation induction pregnancy, and 56 cases after in vitro fertilization and embryo transfer (IVF-ET). The gestational age was 50.2 ± 13.0 days at the time of diagnosis. The most frequent manifestations were abdominal pain (61.5%) and vaginal bleeding (55.4%), while 11 patients (16.9%) had no symptoms before the diagnosis. The primary treatment was expectant and surgical management, including laparotomy and laparoscopic surgery. In the expectant management group, four patients were transferred to surgery due to rupture of ectopic pregnancy or ectopic pregnancy mass gradually enlarged. In the surgical management group, 53 patients underwent laparoscopic surgery, and six underwent laparotomy. The laparoscopic group's mean operation time was 51.3 ± 14.2 min (range: 15-140 min), and the median intraoperative blood loss was 20 mL (range 5-200 mL). In contrast, the laparotomy group's mean operation time was 80.0 ± 25.3 min (range 50-120 min), and the median intraoperative blood loss was 22.5 mL (range 20-50 mL). Four patients had postoperative abortions. Sixty-one newborns had no birth abnormalities, and no developmental malformations were discovered after a median follow-up of 32 months. Expectant treatment has a high failure rate in HP, and laparoscopic surgery is a safe and effective treatment for removing ectopic pregnancy without increasing the risk of abortion or newborn birth defects.

Management of ectopic pregnancy in a tertiary hospital: a retrospective cohort study.

The goal of this study was to manage the treatment modalities of ectopic pregnancy. This retrospective study included 1,103 women diagnosed and treated for ectopic pregnancy at Kanuni Sultan Suleyman Training and Research Hospital between January 1, 2017, and December 31, 2020. Serial beta-human chorionic gonadotropin (β-Hcg) measurements and transvaginal ultrasound (TV USG) findings were used to establish the diagnosis of an ectopic pregnancy. They were divided into four groups: expectant treatment, single-dose methotrexate, multidose methotrexate, and surgical treatment. All data analyses were performed using SPSS version 24.0. A receiver operating characteristic (ROC) analysis was used to determine the cut-off for change in beta-human chorionic gonadotropin (β-hCG) levels between the first and fourth day. There were significant differences between groups in terms of gestational age and β-hCG changes (p < 0.001). In patients receiving expectant treatment, the decrease in β-hCG values on the fourth day was 35.19%, while patients receiving single-dose methotrexate treatment showed a decrease of 24%. The most common risk factor for ectopic pregnancy was the absence of risk factors. Comparison of the surgical treatment group with the other groups revealed significant differences in terms of the presence of free fluid in the abdomen, the average diameter of the ectopic pregnancy mass, and the presence of fetal cardiac activity. A single dose of methotrexate was effective in patients with β-hCG levels lower than 1,227.5 mIU/ml, with a 68.5% sensitivity and 69.1% specificity. An increase in gestational age also leads to an increase in β-hCG values and the diameter of the ectopic focus. As the diagnosis period progresses, the need for surgical intervention increases.

Kliniğimizde Tedavi Edilen Tubal Ektopik Gebelik Olgularında Hemoperitonyumun Önemi ve Retrospektif Analizi

Aim: The purpose of this study is to present the importance of hemoperitoneum and retrospective analysis of tubal ectopic pregnancy cases treated in our clinic.&#x0D; Material and Methods: This study respectively included 86 women who were diagnosed and treated for tubal ectopic pregnancy (EP) in our single-centre clinic between January 2012 and August 2013. Age, date of last menstrual period, human chorionic gonadotropin (β-hCG) level, the size and the presence of tubal EP masses, fetal cardiac activity and treatment procedures were evaluated and compared. The presence of hemoperitoneum for predictive treatment methods and factors that affecting the success of treatment methods were investigated.&#x0D; Results: The mean age of the patients was 29.1±5.7 (16-41) years. Mean β-hCG level was 4448,5±8351,9 IU/L. Laparatomy was performed to 14 patients (16.3%), laparoscopy to 5 patients (5.8%), expectant management to 15 patients (17.4%). Methotrexate (MTX) treatment was given to 46 patients (53.5%) and laparoscopy was performed to 1 patient (1.2%) and laparatomy to 5 patients (5.8%) due to MTX treatment failure in 6 patients. Compared with the MTX treatment of tubal EP, the possible factors that affecting surgical management, such as the initial β-hCG level (p=0.004), whether there is hemorrhage in the abdominal cavity (p=0.03), the size of ectopic pregnancy mass (p=.005) and the presence of fetal heart activity (p

Time to resolution of tubal ectopic pregnancy following methotrexate treatment: A retrospective cohort study.

ObjectiveTo determine the time to resolution of tubal ectopic pregnancy after methotrexate treatment.MethodsA 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.ResultsAmong 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).ConclusionThe 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.

Fertility and reproductive outcome after tubal ectopic pregnancy: comparison among methotrexate, surgery and expectant management

PurposeTo compare fertility and reproductive outcome after surgical, medical, and expectant management for tubal ectopic pregnancy (EP).Methods133 of 228 patients, who were managed between January 2012 and December 2017 for a tubal EP, tried to conceive immediately after treatment: 86 out of 173 (49.7%) underwent surgical treatment; 38 (21.9%) were treated with methotrexate (MTX), and 49 (28.3%) had expectant management. Clinical data were retrieved by medical records, fertility outcomes were obtained by phone follow-up. The cumulative incidence (CI) of intrauterine clinical pregnancy (CP), miscarriage, live birth (LB), and recurrent EP, and the time between treatment and first intrauterine CP were compared between women treated with MTX, surgery and expectant management.ResultsThe CI of intrauterine CP starting from 12 months after the EP was 65.3% for the expectant management, 55.3% for the MTX group, and 39.5% for surgery (p = 0.012). Post-hoc analysis showed expectant management having higher intrauterine CP and LB, and shorter time between treatment and first intrauterine CP compared to surgery (p < 0.05). The CI of recurrent EP was comparable between the 3 groups. The analysis stratified per βhCG cut-off of 1745 mUI/mL and EP mass cut-off of 25 mm reported consistent results.ConclusionsWomen successfully managed by expectation appear to have better reproductive outcomes compared to women who underwent surgery, with the shortest time to achieve a subsequent intrauterine CP. Therefore, if safely applicable the expectant management should be considered in the case of tubal EP. The fact that the chosen treatment was primarily guided by the βhCG value and EP mass diameter based on the protocol, which is intrinsically related to the characteristics of the EP, represents the main limitation of the present study. Indeed, we cannot completely exclude that the observed differences between treatments are related to the EP itself instead of the treatment.

Treatment of tubal heterotopic pregnancy with viable intrauterine pregnancy: Analysis of 81 cases from one tertiary care center

ObjectivesThe aim of our study was to analyze the treatment and pregnancy outcome of tubal heterotopic pregnancy (HP) patients with a viable intrauterine pregnancy (IUP) in our center. Study designThis was a retrospective analysis of 81 patients with tubal HP and a viable IUP. Patients were divided into either an expectant treatment group (29 patients) or a surgical treatment group (52 patients, 36 laparoscopy and 16 laparotomy). Data related to the basal clinical characteristic of all patients, rescue treatment and ectopic pregnancy (EP) rupture rate in the expectant treatment group, operation details in the surgical treatment group and pregnancy outcomes were collected and analyzed. Subgroup analyses were also performed. ResultsIn the expectant treatment group, the abortion rate, EP rupture rate and rescue treatment rate were 10.34 % (3/29), 21.14 % (7/29) and 34.48 % (10/29), respectively; subgroup analysis revealed that the rescue treatment rate in patients with EP mass enlargement ≥50 % was 71.43 % (5/7), which was significantly higher than that in patients with EP mass enlargement <50 % (15.00 %, 3/20), with P = 0.011. In the surgical treatment group, the abortion rate of all patients was 15.38 % (8/52); the abortion rate was 22.22 % (8/36) in the laparoscopy subgroup, which was significantly higher than that in the laparotomy subgroup (0.00 %, 0/16), with P = 0.038. ConclusionsSurgical treatment is a safe treatment option for tubal HP with a viable IUP, and laparoscopic surgery may be a potential risk factor for abortion. A high risk of failure exists for expectant management of tubal HP with a viable IUP, and EP mass enlargement ≥50 % may be a potential predictor of rescue treatment.

Ultrasonographic diagnosis of early unruptured tubal pregnancy in a community hospital

ObjectiveTo investigate ultrasonographic characteristics and diagnostic approaches of unruptured tubal pregnancy (UTP).MethodsOne hundred forty-six cases of early tubal pregnancy, which were confirmed surgically, were analyzed.ResultsAmong 146 cases of UTP, 130 were diagnosed by ultrasonography. Furthermore, 16 cases of UTP were missed by ultrasonography. A total of 130 patients had a mass detected by ultrasonography, among whom the mass and ipsilateral ovary were distinguishable in 102. The embryo sac type was found in 40.00% (52/130), while the heterogeneous mass type was found in 60.00% (78/130) of patients. The maximum length and diameter of the ectopic pregnancy mass ranged from 10 to 68 mm (mean size, 26.42 ± 11.39 mm). No blood flow was observed in or around the mass in 67.69% (88/130) of patients. Lateral tubal thickening of the mass was found in 47.69% (62/130) of patients. Endometrial thickness was ≤10 mm in 67.80% (99/146) of patients. The intima was mostly hyperechoic in 72.60% (106/146) of patients.ConclusionA paraovarian mass, thickened fallopian tube, uterine endometrium with a thickness of ≤10 mm, and high echo are important indicators of early UTP. Ultrasound examinations should focus on these indicators to help improve detection of early tubal pregnancy.

The effect of ultrasonography in predicting medical treatment success in ectopic pregnancy

Ectopic pregnancy(EP) treatment success in a single dose methotrexate(MTX) regimen is decided by more than 15% β chorionic gonadotropin reduction in the 4th and 7th days after administration of 50mg/m² of medication. In our study , it was aimed whether the EP mass size less than 40mm detected by ultrasonography and the adnexal side on which it was located had an effect on the success of medical treatment.&#x0D; 82 patients who treated with MTX included in the study were divided into two groups as those with a single dose of methotrexate success and those without (n:67 vs n:15). The groups were compared in terms of age, parity, size of adnexal mass detected on ultrasonography, and the side of ectopic pregnancy.&#x0D; The parity rates and the age of patients were similar in both groups(p = 0.615, p = 0.742). Although the average adnexal mass size was found to be higher in the patient group those single dose MTX treatment was not successful, there was no statistically significant difference(p = 0.098). Ectopic pregnancy was frequently observed on the right side in the group in which the medical treatment was successful(66 % vs 33%).&#x0D; The effect of ectopic pregnancy mass size on medical treatment prediction was investigated in cases with mass size less than 40mm. Ectopic pregnancy mass size, even if it is below 40 mm, may not indicate the medical treatment success.

Uterine manipulator requirement in laparoscopic surgery of Ectopic Pregnancy.

Objective:The advantages of laparoscopic surgery used in the treatment of ectopic pregnancy is well-known; however, the efficacy of uterine manipulators remains unknown. In this study, we aimed to investigate the efficacy of uterine manipulators in the laparoscopic treatment of ectopic pregnancy.Methods:Overall, 118 patients who underwent laparoscopy due to ectopic pregnancy in Department of Obstetrics and Gynaecology at Tepecik Education and Research Hospital between January 2010 and January 2018 and who met the inclusion criteria were included in the study. Groups of patients undergoing surgery with or without the use of a uterine manipulator were compared in terms of demographic data, operative and postoperative results.Results:No difference was noted between the groups in terms of age, parity, body mass index, smoking, side of ectopic pregnancy mass, previous operations and pregnancy type. However, the size of ectopic pregnancy mass measured by ultrasonography was significantly larger (p = 0.006) and the operation time was significantly shorter (p<0.001) in the group where uterine manipulators were not used than in the uterine manipulator group.Conclusion:We concluded that not using a uterine manipulator in laparoscopic procedures for ectopic pregnancy did not increase operative complications and that operation time was higher in procedures using uterine manipulators.

Caesarean Scar Pregnancy: A Case Series

Caesarean section rate is increasing day by day. Incidence of caesarean scar pregnancy (CSP) is also increasing. Prompt and multidisciplinary approach towards diagnosis of the condition is required to reduce associated morbidity. Major haemorrhage and hysterectomy are the main risks associated with CSP. Therefore, adequate counseling and availability of surgical expertise and blood transfusion should be part of a comprehensive management strategy. There are many single reports in literature but only few case series. In this paper, 10 cases of caesarean scar pregnancy treated in Obstetrics and Gynaecology department of CMH Dhaka, CMH Jashore and Hightech Multicare Hospital Private Limited over 10 years are analyzed. Three of 10 patients had mild pain in their lower abdomen and vaginal bleeding. Seven of them had profuse bleeding during D&amp;C for miscarriage as they were not diagnosed at the time of admission. All patients had 1 or 2 caesarean sections. Gestational age of the pregnancy was estimated from 8 to 12 weeks by the last menstrual period. 9 patients were treated surgically. Eight of them had local resection of ectopic pregnancy mass with conservation of the uterus. One patient was treated with D&amp;C followed by intrauterine balloon catheter insertion to control excessive bleeding. There was no total or subtotal hysterectomy. One patient was treated with Inj. Methotrexate. Common symptoms of caesarean scar pregnancy are pain in the lower abdomen and variable degree of vaginal bleeding. The treatment depends on severity of symptoms, gestational age and experience of the obstetrician dealing these cases.&#x0D; J Bangladesh Coll Phys Surg 2019; 37(4): 191-195

Single dose Methotrexate injection, could be a safe and effective treatment for early cases of tubal ectopic pregnancy, with minimal maternal health hazards

first method is described as a conservative medical method in which we use a chemotherapeutic agent (Methotrexate) to eradicate the ectopic tubal conception, whereas the second method implies a conservative laparoscopic surgery in which overwhelming efforts are done in order to maintain a tube affected by ectopic pregnancy as healthy as possible following removal of the ectopic pregnancy mass. The fallopian tubes are assessed for patency and tubal lumen contour and pattern 3 months following successful treatment, in order to detect which method would lead to a high cure rate with the least tubal detrimental effect. Patients and Methods: In the current study, 58 patients diagnosed with tubal ectopic pregnancy were given Methotrexate as a first choice chemotherapeutic agent aiming to resolve the ectopic pregnancy, whereas 58 patients with the same condition gone directly through laparoscopic salpingostomy, with the aim of maintaining patent healthy tube finally after successful treatment. Results: The study revealed no significant difference for either treatment modalities in affecting the rate of bilateral tubal obstruction, or tubal patency with a recognized tubal defect with a p >0.05. On the other hand, cases with unilateral tubal obstruction involving the affected tube were remarkably increased in the methotrexate group (13 cases) out of 52 cases with successful treatment compared to 6 cases successfully treated by salpingostomy (6 cases) out of 52 cases successfully treated, with a p<0.05 . Conclusion: In conclusion, single dose methotrexate has proven to be a safe, effective and reasonably convenient treatment for most patients, shown during counseling to be so worry about surgery and its potential detrimental consequences on their future fertility. Yet, it should be obviously highlighted that such concepts and perspectives for keeping fertility can’t be taken as for granted and a guarantee for a healthy patent tube as it is quite obvious that even with successful elimination of the chorionic tissue in the tube, the affected tube might still be blocked and with a significant rate further exceeding the excepted rate with laparoscopic salpingostomy.

Relationship Between Ultrasonographic and Biochemical Markers of Tubal Ectopic Pregnancy and Success of Subsequent Management.

To determine whether there is an association between morphologic types of tubal ectopic pregnancy (EP), 0-hour human chorionic gonadotropin (hCG) levels, and subsequent management success. We conducted a prospective study (November 2006-December 2015). Women had a diagnosis of EP by transvaginal ultrasonography if they had an inhomogeneous mass adjacent to the ovary and moving separately from it ("blob" sign), a mass with a hyperechoic ring around the gestational sac ("bagel" sign), or a gestational sac with an embryonic pole with or without a yolk sac with or without cardiac activity. The morphologic type, EP size, and 0-hour hCG level were analyzed. A multivariate analysis determined any correlation between these variables and nonsurgical management success. A total of 7350 consecutive women underwent transvaginal ultrasonography, of whom 301 (4.2%) had a diagnosis of tubal EP; 181 (60.1%) had the blob sign; 90 (29.9%) had the bagel sign; and 23 (7.6%) were noted to have an embryo (14 viable and 9 nonviable). Eighty-three of 301(27.5%) women had expectant management; 67 of 301(22.2%) were given methotrexate; and 151 of 301 (50%) had surgery. Success rates for the groups were 77%, 75%, and 100%, respectively. No difference between the morphologic type and success rate of treatment was noted. Although there was a significant correlation between the EP mass size and 0-hour hCG level, the mass size itself was not correlated with the success rate of either medical or expectant management. Overall higher 0-hour hCG levels were associated with management failure. In the expectant group, median hCG level for failure was 589 IU/L versus 366 IU/L for success, whereas in the medical group, the median for failure was 1244 IU/L versus 7629 IU/L for success. There is no significant correlation between the morphologic type and size of EP with a nonsurgical management outcome. A likely successful outcome is related to a lower level of serum hCG at presentation.

Density of tubal ring vascularization: A new marker for prediction of success of medical treatment in tubal ectopic pregnancy

ObjectivesThe diagnosis of ectopic pregnancy has been facilitated especially by the use of Doppler ultrasonography. In previous studies the presence of peri-trophoblastic blood flow by Doppler ultrasound and the detection of a low-resistance, high-velocity flow pattern were defined as specific signs for trophoblastic tissue. The aim of this study was to evaluate the efficacy of Doppler ultrasonography in the prediction of treatment success in tubal pregnancies being treated with single dose conservative methotrexate. Study designA total of 104 patients with non-ruptured ectopic pregnancy who were hemodynamically stable and eligible for methotrexate treatment were included in the study. The spectral wave form of the mass was classified according to the vascularization density by Power Doppler. It was defined as Grade 1, 2 and 3, respectively. All patients received a single 50mg/m2 dose of systemic methotrexate. Serum β-hCG levels were measured on the 4th and 7th days of treatment. The treatment was considered unsuccessful in patients without a decrease of 15% or more in the serum β-hCG levels between days 0 and 7. ResultsTwenty-four patients with grade I vascularity, 11 patients with grade II vascularity and 13 patients with grade III vascularity were referred as Group I, II and III, respectively, according to the degree of adnexal vascularity assessed by Doppler ultrasonography. Overall success rate of MTX treatment was found to be 72.9%. The response rates to systemic MTX treatment in cases with Grade I, II and III ectopic pregnancy mass vascularization were found to be 58.3%, 81.8% and 92.3%, respectively. Comparison of the groups’ treatment responses revealed a linear-by-linear correlation with the Chi-square test. Increased vascularization grade of ectopic pregnancy was associated with a higher likelihood of responding to MTX treatment. ConclusionsDetection of the vascularization grade with Doppler ultrasound could be considered a remarkable parameter in predicting treatment success considering its ease of utilization and low cost.

Unusually Large, Unruptured Tubal Ectopic Pregnancy Mass in a Woman With Bilateral Tubal Obstruction Treated by Laparoscopy: A Case Report

A tubal ectopic pregnancy mass usually measures 1.5 - 3.5 cm, and ruptures if it grows beyond this size. The author encountered a case of an unruptured, tubal ectopic pregnancy mass measuring up to 7.3 cm, containing an embryo with a crown-rump length (CRL) of 2.02 cm, corresponding to 8 weeks, 4 days. To the author’s knowledge, this is the largest reported singleton tubal ectopic pregnancy mass. A 36-year-old gravida 0, para 0 woman presented with a history of mild vaginal bleeding, lower abdominal pain, and 8 weeks of amenorrhea. Vaginal bleeding started 3 weeks before, but she mistook this for menstruation. Her menstrual cycle ranged between 28 and 30 days and lasted 6 days. Her last menstrual period was about 8 weeks prior. She had an appendectomy 22 years prior. She was diagnosed with infertility due to tubal obstruction and underwent laparoscopic fimbrioplasty at another general hospital 13 years prior. She was told that her Fallopian tubes were still obstructed on hysterosalpingography after fimbrioplasty. She had not used contraception. On arrival in the emergency room, her serum beta-human chorionic gonadotropin (hCG) level was 15,944 mIU/mL. The transvaginal ultrasound scan (TVUS) demonstrated an ectopic pregnancy mass measuring 7.3 × 4.0 cm in the left adnexa. An embryo with CRL of 2.02 cm corresponding to 8 weeks, 4 days was noted in the ectopic pregnancy mass. Upon entering the pelvic cavity, a dark reddish-colored unruptured tubal ectopic pregnancy mass was noted. Laparoscopic salpingectomy was carried out. The right Fallopian tube was adherent to the right pelvic wall. Even though the Fallopian tubes are obstructed, pregnancy is still possible. Laboratory studies should always include a pregnancy test. A large tubal ectopic pregnancy mass could have developed when a blastocyst was implanted in a fused Fallopian tube that was adherent to the pelvic peritoneum and uterus. J Med Cases. 2016;7(9):396-398 doi: http://dx.doi.org/10.14740/jmc2613w

Unusually Large, Unruptured Tubal Ectopic Pregnancy Mass in a Woman With Bilateral Tubal Obstruction Treated by Laparoscopy: A Case Report

Unusually Large, Unruptured Tubal Ectopic Pregnancy Mass in a Woman With Bilateral Tubal Obstruction Treated by Laparoscopy: A Case Report

Frequency and related factors of tubal patency after methotrexate treatment in women with ectopic pregnancy.

Ectopic pregnancy is a medical emergency. The classic treatment for this condition is surgery but early diagnosis allows for non-surgical treatment. In recent years, intramuscular methotrexate has been considered, due to easy administration, its less invasive nature and low complications, but there are arguments about its effects. The aim of this study was to evaluate tubal patency after treatment of ectopic pregnancy with methotrexate and related factors. This cross-sectional study was conducted on 80 women with ectopic pregnancy who were admitted to Sanandaj Be'sat Hospital in 2014. Patients who had successful treatment for ectopic pregnancy with single or multiple doses of methotrexate 50 mL/m(2) were enrolled. Three to 6 months after treatment, the patients were evaluated for tubal patency by hysterosalpingography. Data were analyzed using spss, t-tests, χ(2) -test and logistic regression. The tubal patency rate after treatment of ectopic pregnancy with methotrexate was 75% in hysterosalpingography. The average size of the ectopic pregnancy mass of women with open fallopian tubes was 22.5 ± 7.0mm and for women with closed fallopian tubes it was 34.7 ± 10.0mm (P = 0.0001). β-human chorionic gonadotropin levels were 642.1±850.5 in women with open fallopian tubes and 3816.3±4487.3 for women with closed fallopian tubes (P = 0.0001). There was no significant correlation statistically between tubal patency with a history of stillbirth and number of pregnancies (P > 0.5). There was a statistically significant relation between tubal patency and the number of births and also methotrexate dose (P < 0.05). Treatment of ectopic pregnancy with methotrexate is effective for saving tubal patency. Levels of human chorionic gonadotrophin-β<1745, the treatment regimen of methotrexate (single or multiple doses) and ectopic pregnancy mass size smaller than 33.5 mm are significant predictors of tubal patency.

The clinical observation of methotrexate under hysteroscopy by tubal cavity injection with Huayu shapei prescription in the treatment of tubal pregnancy

Objective To explore the clinical effects of injecting methotrexate with hysteroscopic tubal cannulation combined with Huayu shapei prescription in the treatment of salpingocyesis. Methods 82 unruptured salpingocyesis patients were randomly divided into the two groups.41 patients in the observation group were treated by hysteroscopic tubal cannulation injection of methotrexate combined with Huayu shapei prescription,41 patients in the control group were treated by methotrexate intramuscular injection with oral mifepristone.The clinical efficacy of the two groups were observed, the level of serum β HCG required for tubal pregnancy, the mass absorption and after treatment of tubal patency. Results Compared with the control group, the difference was significant of the decline of serum β HCG in the treatment group(t= 2.67,P< 0.05). Compared with the control group, the treatment effectiveness and the absorption of the mass in fallopian tube in the treatment group, the difference was significant(t= 3.57,P< 0.05). Tubal patency detected treated group was superior compared with the control group, the difference was significant(χ2= 100.23,P<0.05). Conclusion Compared with traditional treatments, injecting methotrexate with hysteroscopic tubal cannulation combined with Huayu shapei prescription in the treatment of salpingocyesis can effectively reduce the HCG levels, promote the absorption and softening of the ectopic pregnancy mass, to achieve the purpose of killing embryos eliminate micro, it will help to improve patients with clinical symptoms and signs, to maximize the recovery of the patient's reproductive function and physical health. Key words: Uteroscop; Prescription salpingocyesis; Methotrexate; Huayu shapei

Predictors of Success of a Single-Dose Methotrexate in the Treatment of Ectopic Pregnancy.

Ectopic pregnancy (EP) is the commonest cause of maternal mortality-related death in the first trimester. Methotrexate (MTX) remains the first-line treatment in optimally selected patients. To evaluate the success rate and predictors of success of a single-dose MTX treatment in EP. We studied retrospectively 109 patients with unruptured EP who were treated with Intramuscular MTX administered in a dose of 50mg/m(2) on days 0 and in additional doses on day 7 if β-hCG levels did not decrease by 15% during the follow-up period. The study was conducted at the Maternity and Children Hospital Buraidah, Saudi Arabia from June 2013 to December 2013. Pretreatment β-β-hCG, EP mass diameter, peritoneal fluid, and fetal cardiac activity were evaluated. The main outcome measures were success rate, the predictors of success without surgical treatment. Under this regime, the overall success rate was 60.6% of patients. Of the failure group, only 4.7% of patients experienced rupture of EP. No side effects were reported. The main predictors of failure were initial β-hCG value≥3.500 mIU/mL OR 4.11 (1.646-12.248, 0.043) and EP diameter 3.73 (1.646-12.10, p=0.003). The success rate of MTX in this study was 60.6%, and the initial β-hCG concentration and EP diameter were the best predictors of successful treatment with MTX. Furthermore, MTX should be offered only to those patients with β-hCG<2,000mIU/mL and EP mass size<3.5cm.

OC19.01: Is size of tubal ectopic pregnancy mass a predictor of successful conservative management?

<scp>OC</scp>19.01: Is size of tubal ectopic pregnancy mass a predictor of successful conservative management?