Medical Treatment Of Ectopic Pregnancy Research Articles

Clinical Presentation as a Predictor of the Response to Methotrexate Therapy in Patients with Ectopic Pregnancy.

Ectopic pregnancy can be fatal if not diagnosed and timely treated. There is an increase in ectopic pregnancy rate which attributes in part to fertility medications and procedures and early diagnosis. Methotrexate, a folic acid antagonist, is widely used in the medical treatment of ectopic pregnancy. Many studies examined the safety and success rate of methotrexate looking into factors affecting the success rate, if the patient may present with symptoms such as abdominal pain, and some consider this as impeding rupture and it might affect the success of medical treatment. This study evaluates the success rate of methotrexate treatment outcomes in regard to presentation and looks into other factors that can help choosing a single or multiple dose modality. This is a retrospective review of 154 cases of ectopic pregnancy treated with methotrexate from January 2011 to December 2020 at King Khalid University Hospital (KKUH). Demographic data, clinical presentation, treatment progress, and outcome and failure rate were collected and analyzed. Student's t-test was used for statistical analysis of associations in SPSS. 154 patients were treated with MTX; of those patients, 25 received more than one dose. The difference between the responses to MTX treatment in symptomatic and asymptomatic individuals was not significant (p = 0.267). 131 (85%) had successful treatment. There were no associations between patient BMI, ectopic mass size, or ectopic mass site, the presence or absence of pelvic fluid on ultrasound at diagnosis, and the treatment success rate. There was a significant decline in the treatment success rate with increasing β-hCG levels on the presentation day (p = 0.035) and on day 4 (p value <0.001) of treatment. MTX treatment can be used to manage symptomatic patients with ectopic pregnancy. The success rate in symptomatic patients is not different from that in asymptomatic patients. β - hCG levels > 5000 IU/L. Pretreatment and on day 4 posttreatment is associated with higher failure rate.

Evaluation of Different Doses of the Aromatase Inhibitor Letrozole for the Treatment of Ectopic Pregnancy and Its Effect on Villous Trophoblastic Tissue

Letrozole, an aromatase inhibitor, has recently been introduced as a favorable medical treatment for ectopic pregnancy. We aimed at evaluating the effects of different doses of letrozole for termination of ectopic pregnancy and study their effects on villous trophoblastic tissue. Sixty patients with undisturbed ectopic pregnancy were classified into three equal groups. Group I: the control group that contained women who underwent laparoscopic salpingectomy, Group II: patients who received letrozole (5 mg day−1) for 10 days, and Group III: patients who received letrozole (10 mg day−1) for 10 days. Subsequently, the β-hCG levels were determined on the first day and after 11 days of treatment. Group IV consisted of patients of GII and GIII; their β-hCG did not drop below 100 mIU/ml within 11 days, and underwent salpingectomy. Placental tissues from patients undergoing salpingectomy either from the control group or GIV were processed for the evaluation of estrogen (ER) and progesterone (PR) receptors, vascular endothelial growth factor (VEGF), and cleaved caspase 3 (CC-3) expression. Cases exposed to high dose letrozole 10 mg day−1 resulted in a higher ectopic pregnancy resolution rate of 85% (17/20), while the resolution rate of the low dose letrozole-treated group (5 mg day−1) was 65% (13/20), and also showed a significant reduction in β-hCG levels on the 11th day, 25.63 ± 4.29 compared to the low dose letrozole group 37.91 ± 7.18 (P < 0.001), Meanwhile, the letrozole-treated group GIV showed markedly reduced expression of ER, PR, and VEGF and a significant increase in the apoptotic index cleaved caspase-3 compared to the control group (P < 0.001). The utilization of letrozole at a dose of 10 mg day−1 for medical treatment of ectopic pregnancy results in a high-successful rate without any severe side effects. Letrozole depriving the placenta of estrogen that had vascular supporting signals resulted in destroying the vascular network with marked apoptosis.Graphical abstract

Facteurs associés à l’échec du traitement médical de la grossesse extra-utérine: cas de l’Hôpital Gyneco-Obstétrique et Pédiatrique de Yaoundé

Introductionl´objectif de notre travail était d´identifier les facteurs associés à l´échec du traitement médical de la grossesse extra-utérine (GEU) chez les femmes à l´Hôpital Gynéco- Obstétrique et Pédiatrique de Yaoundé.Méthodesil s´agissait d´une étude cas-témoins avec collecte rétrospective des données, sur une période de 10 ans, du 1er janvier 2008 au 31 décembre 2017. Les cas étaient toutes les patientes prises en charge pour GEU avec échec du traitement médical et les témoins celles chez qui le traitement médical de la GEU avait réussi. Les variables étudiées étaient: les caractéristiques sociodémographiques, cliniques, paracliniques et thérapeutiques. L´échantillonnage était consécutif et exhaustif. Nous avons réalisé une analyse multivariée.Résultatsnous avons recruté 92 patientes dont 23 cas et 69 témoins. Les variables associées à l´échec du traitement médical de la GEU après analyse univariée étaient: un taux de β-HCG initial > 10000UI/L (OR=3,05;P=0,031), un taux de β-HCG à J4 > 10000UI/L (OR=7,15;P=0,000), un taux de β-HCG à J7 > à 10000UI/L (OR=20;P=0,000), un score de Fernandez ≥ 13 (OR=3,09;P=0,020), la présence d´activité cardiaque de l´embryon (OR=2,8;P=0,036), l´antécédent d´interruption volontaire de grossesse (OR=2,67;P=0,043) et le niveau de scolarisation primaire (P=0,013). Après analyse multivariée, les facteurs prédictifs étaient: un taux de β-HCG initial >10000 UI/L (OR=8,97; P=0,004), un taux de β-HCG à J4 >10000 UI/L (OR=8,44;P= 0,007), un score de Fernandez ≥ 13 (OR=1,12;P=0,005) et la présence de l´activité cardiaque de l´embryon (OR=6,09;P=0,026).Conclusionles facteurs prédictifs de l´échec du traitement médical de la GEU à HGOPY sont liés au taux de β-HCG initial et la viabilité embryonnaire.

Undisturbed tubal pregnancies with positive fetal heart treated medically: Case study.

The incidence of ectopic pregnancy (EP) is 1.3-2.4%. Suspicion of EP starts after a positive serum pregnancy test and failure to visualize the intrauterine gestational sac (GS) by transvaginal sonography (TVS). About 88% of tubal EPs are diagnosed by absent intrauterine GS and the presence of an adnexal mass during TVS. Medical treatment of EP using methotrexate (MTX) is cost-effective with a similar success rate to surgical treatment. The presence of fetal heart beats, β-human chorionic gonadotropin >5000 mIU/mL, and EP size >4 cm are relative contraindications for using MTX in the treatment of EP.

The Use of Beta-Human Chorionic Gonadotropin (β-hCG) Levels as a Predictor of Successful Medical Management of Ectopic Pregnancy.

ObjectivesThe early diagnosis of ectopic pregnancy is essential in determining the appropriate therapeutic approach. This study demonstrates the important factors considered in the prediction of a successful medical treatment, which will, in turn, improve the quality of patient counseling and guidance prior to the initiation of the treatment.MethodsThis was a retrospective cohort study of 58 ectopic pregnancies that were treated medically with methotrexate in Bahrain Defense Force (BDF) Hospital from January 2016 to January 2021. All patients that were offered medical treatment of ectopic pregnancy and completed the follow-up were included in the study. StatsDirect software was used to analyze the baseline characteristics of the successful and failed medical treatment of ectopic groups. Simple linear regression was used to correlate initial beta-human chorionic gonadotropin (β-hCG) levels and the drop of β-hCG levels after one week of medical treatment.ResultsPatients were divided into two outcomes: the primary outcome represented in the successful treatment group, 68.9% (40/58), and the secondary outcome represented in the unsuccessful treatment group 31% (18/58). The mean β-hCG level in the successful group was significantly lower than that of the unsuccessful treatment group (1403.6±1421 IU/L versus 2845.1±1705 IU/L, p=0.001). There were no differences between the two groups with regards to the size of the adnexal mass, presence of gestational sac, or size of the gestational sac. The cut-off value of the initial β-hCG level for successful medical treatment was 2,141 IU/L, with 72% sensitivity, 75% specificity, and receiver operator curve (ROC) of 0.76 [95% confidence interval (CI) = 0.63 to 0.89)]. The cut-off value of β-hCG fell between day four and day seven and was 37.2%, with 78% sensitivity, 68% specificity, and a ROC curve of 0.72 (95% CI = 0.55 to 0.89).ConclusionThis study found that low initial β-hCG levels can be used to predict successful methotrexate treatment of ectopic pregnancy. In this cohort of patients, the cut-off level of initial β-hCG for successful treatment was 2141 IU/L.

Methotrexate Treatment of Ectopic Pregnancy: Prognosis at Senlis Hospital

Introduction: Ectopic pregnancy is dreadful and can lead to the death of the patient if it is ignored. Diagnosed early, it offers the possibility of medical treatment with methotrexate. Objective: To describe the prognosis of ectopic pregnancies treated methotrexate. Patients and Methods: Retrospective study of the management of ectopic pregnancy by Methotrexate at Senlis hospital from June 2020 to May 2021 were included in the study, patients with a Fernandez score of less than 13, and having received Methotrexate as first-line treatment. Data were collected using gynecological emergency admission registers, and telephone interviews. Results: 35 cases were identified. The average age of the patients was 32 years old. Forty-nine percent were smokers. The mean gestational age was 5 weeks + 2 days. The diagnosis was made in all of our patients with the combination of the kinetics of ß-hcg and vaginal ultrasound. The size of adnexal mass was less than 4 cm with an average size of 20 mm. The average value of ß-hcg was 1405 IU/L. All patients had received a single dose of methotrexate 1 mg/kg intramuscularly. A second dose was administered to 17.1% of patients for stagnation or re-ascension of the ß-hcg level. The success rate was 91.4%. Thirty percent were obtained spontaneous intra uterine pregnancy, the first year following methotrexate treatment. Conclusion: The success rate of medical treatment for ectopic pregnancy is high in terms of meeting the eligibility criteria for treatment. The subsequent prognosis of fertility is generally preserved.

Aromatase inhibitor letrozole: a novel treatment for ectopic pregnancy

To study the use of the aromatase inhibitor letrozole for treatment of ectopic pregnancy compared with methotrexate. Nonrandomized prospective cohort study. University hospital. A series of 42 consecutive patients with undisturbed ectopic pregnancy. Counseling on treatment options, including surgical treatment (control group) versus medical treatment with methotrexate (group 1) or letrozole (group 2). Primary outcome: complete resolution of ectopic pregnancy determined by serum human chorionic gonadotropin (β-hCG) levels below laboratory immunoassay detection. changes in the biochemical parameter of ovarian reserve, antimüllerian hormone (AMH), and hematologic changes associated with the two medical treatments compared with surgical treatment. Each treatment group included 14 patients, and each patient made her own treatment choice. Complete resolution of ectopic pregnancy occurred in an equal number of patients: 12 out of 14 (86%) in each of the two medical treatment groups. Methotrexate treatment was associated with statistically significantly higher liver enzymes and lower blood platelets count. The decline in β-hCG levels was faster in the letrozole group when compared with the methotrexate group. Three months after treatment, AMH levels were lower in the methotrexate group when compared with the letrozole and the surgery groups. However, the decline in β-hCG and AMH levels was not statistically significant. To our knowledge, this is the first report in the literature on the success of letrozole for the medical treatment of ectopic pregnancy. The promisingly high resolution rate and better safety profile that letrozole has compared with a chemotherapeutic agent such as methotrexate should encourage further studies.

Successful Management of Live Ectopic Pregnancy with High B-Hcg Titres by Systemic Methotrexate Injection: A Case Report

Background: Use of methotrexate (MTX) as a nonsurgical management of unruptured ectopic pregnancies has been well accepted. However, use of it in high serum chorionic gonadotropin concentration and in live fetus has been considered as relative contraindication for medical therapy. The aim of this report is to emphasize that these contraindications can be revisable in some situations and discuss about this fact that the success rate can be affected by the type of protocols used for medical treatment. Case presentation: A 31 years old primigravid woman was admitted to our hospital due to a sonogram's report of ectopic pregnancy with a high initial serum B-hCG concentration (26900) and presence of fetal cardiac activity. Her vital signs were stable and she did not agree with operative intervention. Two-dose protocol was scheduled but appropriate response to treatment was obtained after receiving the third dose of methotrexate. Negative serum B-hCG (< 1 mIu/ml) was achieved on day 80 without any related treatment complication on follow up. Conclusions: Use of double- dose protocols of MTX in medical treatment of ectopic pregnancy increase the chance of successful and nonsurgical treatment even in live fetus with high B-hCG titers.

ECTOPIC PREGNANCY AND ITS LONG-TERM RESULTS

The aim: The purpose of this study was to assess the long-term outcomes of restoration of reproductive function after surgical and medical treatment of ectopic pregnancy, taking into consideration the patency of the fallopian tubes and the incidence of uterine pregnancy. Materials and methods: A two-stage experimental approach was used to address research objectives. In the first stage, a retrospective analysis of 615 histories of patients with ectopic pregnancy has been performed. In a second stage - we examined 140 patients, which were divided into three groups, depending on the type of treatment. The first group consisted of patients with a disturbed ectopic pregnancy, who were treated with laparotomy and tubectomy. The second group included patients with exacerbated ectopic pregnancy, who were operated by laparoscopic access. Lastly, the third group comprised of women with ectopic pregnancy who were treated with methotrexate. The main source of information used for clinical and anamnestic analysis was "medical card-patient" (f. 003 / o). Results: The number of patients diagnosed with ectopic pregnancy increased from 2005 to 2015. In 2005 and 2006, the laparotomy operations were 86.88% and 83.33%, but conservative management only 13,16% and 16,67%, respectively. In 2015, the number of patients treated with methotrexate was more than half (51.35%) compared with 2010 and 2005 increased to 16.97% and 38.19% respectively, and laparotomy operations decreased from 86.88% in year 2005 to 18.92% in year 2015. Conclusions: The data showed that in women who underwent medical treatment with cytostatic, the patency of the fallopian tubes was significantly better than after surgical treatment. In cases of interrupted ectopic pregnancy for which laparotomy with the removal of the motor tube was applied, infertility of tubal peritoneal genesis developed in 60% of cases, which is consistent with the existing literature. Statistical analysis of the structure of ectopic pregnancy showed that in 2005 dominated interrupted ectopic pregnancy, due to late diagnostic and hospitalisation, that led to urgent laparotomy operations rather than conservative treatment.

1225 Early Prediction of Methotrexate Treatment Success by 24‐Hour Pretreatment HCG Increment and Day 1-4 HCG Ratio

Study Objective Several studies have tried to identify early markers for treatment outcome after methotrexate (MTX) treatment for an ectopic pregnancy (EP) including pretreatment and day 4 hCG levels and corresponding ratio, and hCG increment during the initial 24 hours following treatment, with conflicting results. We aim to re‐evaluate the role the aforementioned markers in the earlier identification of treatment success in a large cohort of women. Design A retrospective cohort study. Setting A tertiary medical center during 2010-2018. Patients or Participants All women diagnosed with an EP and treated by intention of single-dose regimen of intramuscular MTX. Interventions A comparison of maternal and gestation characteristics was performed between treatment success and failure groups. Measurements and Main Results 292 women treated with single-dose intramuscular MTX for EP during were included in this study. Treatment success rate with a single dose of MTX of the overall cohort was 62.7% (183/292). Only two independent determinants were significantly associated with the treatment success: initial 24 hours hCG percentage of increment (adjusted odds ratio [OR]: 1.82; 95% confidence intervals [CI]: 1.26, 2.63; p Conclusion A low rise in hCG levels 24 hours prior to treatment with MTX, alongside a decline in hCG levels from day 1 to day 4 may predict success of medical treatment of EP.

The aromatase inhibitor, letrozole: a novel treatment for ectopic pregnancy

Study the use of the aromatase inhibitor, letrozole, for the treatment of ectopic pregnancy compared to methotrexate. Non-randomized prospective cohort study. A series of 42 consecutive patients with undisturbed ectopic pregnancy were counseled regarding the treatment options including surgical treatment (control group), medical treatment with the methotrexate (study group 1) or letrozole (study group 2). Each group included 14 patients. Primary outcome was complete resolution of ectopic pregnancy determined by serum hCG levels below laboratory immunoassay detection. Secondary outcomes included changes in the biochemical parameter of ovarian reserve, Anti-Mullerian Hormone (AMH), as well as hematological and hormonal changes associated with the two medical treatments compared to surgical treatment. Complete resolution of ectopic pregnancy occurred in equal number of patients, 12 out of 14 (86%) in each of the two study groups. The two patients who failed methotrexat treatment had to undergo surgery after becoming hemostatically unstable, while in the letrozole group, one patient had to go to surgery when she became hemostatically unstable, while in the second patient, a decision to do surgery was due to failure of hCG level to decline four days after letrozole treatment. Treatment with methotrexate was associated with higher levels of liver enzymes, and lower levels of platelets (the differences in both parameters were statistically significant) . The decline in hCG levels was faster in the letrozole group, when compared to the methotrexate group. Three months after treatment, AHM levels were lower in the methotrexate group when compared to the letrozole and the surgery group. However, the decline in the hCG and AMH levels were not statistically significant. Up to our knowledge, this is the first report in the literature on the success of letrozole in medical treatment of ectopic pregnancy. In the absence of estrogen priming, progesterone may not exert its physiological functions due to a negative effect on progesterone receptors. We hypothesized that by inhibiting the estrogen synthetase (the aromatase enzyme), the progesterone would not exert its physiological function in maintaining pregnancy, including ectopic pregnancy. The small sample size and non-randomized design of our study would limit our conclusion about letrozole success in treating ectopic pregnancy. However, the promising high resolution rate and better safety profile that letrozole has over a chemotherapeutic agent like methotrexate, should encourage studying the letrozole as a promising medical treatment for ectopic pregnancy through more definitive randomized clinical trials, that are adequately powered. Furthermore, letrozole may also be a safer alternative instead of surgical approach in managing early pregnancy loss, and pregnancy termination when medically indicated and ethically appropriate. In our study, a long follow up is intended to compare ovarian reserve in the two study groups and the surgery control group.

Does medical treatment of ectopic pregnancy with methotrexate have better subsequent fertility outcomes than surgical treatment?

Does medical treatment of ectopic pregnancy with methotrexate have better subsequent fertility outcomes than surgical treatment?

Study of single dose methotrexate for medical treatment of ectopic pregnancy

Study of single dose methotrexate for medical treatment of ectopic pregnancy

Systematic review and meta-analysis of single-dose and non-single-dose methotrexate protocols in the treatment of ectopic pregnancy.

It remains unclear which methotrexate protocol for the treatment of ectopic pregnancy has a higher success rate or a higher adverse effect rate. To compare the treatment success rates and adverse effect rates of single-dose and non-single-dose (two-dose and multi-dose) methotrexate protocols in the treatment of ectopic pregnancy. Various databases including Medline, Embase, and the Cochrane Central Register of Controlled Trials were searched on July 1, 2017, using search terms including "methotrexate" and "pregnancy." Randomized controlled trials comparing different methotrexate protocols for the treatment of ectopic pregnancy were included. Relative risks (RRs) and 95% confidence intervals (CIs) were calculated to compare treatment success rates and adverse effect rates. The single-dose and non-single-dose protocols had similar success rates (RR 1.00, 95% CI 0.96-1.04; 11 trials, 1121 patients, I2 =18%). The non-single-dose protocols had a higher adverse effect rate than did the single-dose protocol (RR 0.73, 95% CI 0.59-0.91; nine trials, 934 patients, I2 =0%). The single-dose methotrexate protocol was the optimal protocol for the medical treatment of ectopic pregnancy.

Conservative Treatment with Methotrexate of Ectopic Pregnancy

As a life threatening condition ectopic pregnancy has gained a lot of concerned by physicians To avoid unnecessary surgical treatment conservative medical treatment with methotrexate has been used intensively Although other alternative conservative treatments are available methotrexate is still popular due to its convenience safety and effectiveness This mini review covers general idea of methotrexate as a conservative medical treatment for ectopic pregnancy

172 - Medical Treatment of Ectopic Pregnancy in a Tertiary Hospital in Brazil

Study Objective: Evaluate the use of methotrexate (MTX) in the treatment of ectopic pregnancy in the emergency unit of a tertiary hospital in Brazil.

Predictive factors for the methotrexate treatment outcome in ectopic pregnancy: A comparative study of 400 cases

ObjectiveWe sought to evaluate the global success rate of intramuscular methotrexate for the treatment of ectopic pregnancy, identify factors predictive of treatment success or failure, and study methotrexate tolerability in a large patient cohort. Study designFor this single-center retrospective observational study, we retrieved the records of all women who had a clinically or echographically confirmed ectopic pregnancy with a Fernandez score <13 and who were treated according to a 1mg/kg intramuscular single-dose methotrexate protocol. Medical treatment failure was defined by an obligation to proceed to laparoscopy. Needing a second injection was not considered to be medical treatment failure. ResultsBetween February 2008 and November 2013 (69 months), 400 women received methotrexate for ectopic pregnancy. The medical treatment protocol was effective for 314 patients, i.e., an overall success rate of 78.5%. A single methotrexate dose was sufficient for 63.5% of the women and a second dose was successful for 73.2% of the remaining women. The medical treatment success rate fell as initial hCG levels climbed. The main factors associated with methotrexate failure included day (D) 0, D4 and D7 hCG levels, pretherapeutic blood progesterone, hematosalpinx at D0 and pain at D7. Early favorable kinetics of hCG levels was predictive of success. Methotrexate treatment was successful in 90% of women who had D0 hCG <1000IU/l. Methotrexate tolerability was good, with only 9% of the women reporting non-severe adverse effects. The fertility rate with delivery after medical treatment for ectopic pregnancy was 80.7%. ConclusionIn this study, we showed that an initial hCG value <1000IU/l and favorable early HCG kinetics were predictive factors for the successful medical treatment of ectopic pregnancy by methotrexate, and hematosalpinx and pretherapeutic blood progesterone >5ng/ml at diagnosis were predictive of its failure. We also confirmed good tolerability for single-dose methotrexate protocols.

Experience of a unit for the pathology of early pregnancy and ectopic pregnancy

Objective: The study was undertaken to evaluate the utility in term of diagnosis, treatment, outcomes and drop out of an ambulatory management of first trimester pathology. Study design: Retrospective review of patients seen in our Early Pregnancy Unit, in Macedonio Melloni Hospital (Milan – Italy) in a period from January 2009 to December 2015 Results: We evaluated a total of 1751 women in childbearing age. The reason of the first access in our ambulatory was: in 112 cases the need of control because an anechoic sac was seen in the uterus but there were not a certain diagnosis of physiological pregnancy. Among these, we diagnosed 23 ectopic pregnancy, 658 miscarriage, 428 intra uterine pregnancy, 8 molar pregnancy. In 271 first access, the reason was an uncertain localization pregnancy. Among these, we diagnosed 131 miscarriage, 53 ectopic pregnancy, 85 intrauterine pregnancy. In 16 patient the reason was a suspected molar pregnancy and we found 6 molar pregnancy, 8 miscarriage, 2 intrauterine pregnancy. 214 patients were referred to our ambulatory for the need of a follow up. Among these, we had in 55 cases a follow up for molar pregnancy, in 59 cases a follow up after medical treatment of ectopic pregnancy with methotrexate, in 19 women a control after laparoscopic surgery for ectopic pregnancy and in 81 patients a control after surgical treatment of miscarriage for some finds, as idropic degeneration of trophoblast, at the istological analysis. In total we were able to perform expectant management for ectopic pregnancy in 23 cases and medical therapy with methotrexate in 117 cases. We had just 2 cases of failure of the conservative medical treatment for ectopic pregnancy, who underwent laparoscopic surgery. The mean time for the diagnosis, calculated from first access to emergency of a symptomatic woman in total absence of a diagnosis to the day of decision about treatment, which means a certain diagnosis, was 10 days (range 1–23 days). The drop out of patients was very low with only 9 cases. Conclusion: For several years, in treating ectopic pregnancy, less frequently the need and the purpose is to save the life of the patient but increasingly it is to preserve her fertility. Diagnosis is often early and, above all, it often takes place before when the haemoperitoneum constitutes a serious life-threatening for the patient. The presence of the Early Pregnancy Unit in our Hospital permitted to perform a conservative treatment in the 47% of all cases of ectopic pregnancy. This result was possible because of an early diagnosis and of a timely treatment with a well organized follow up. It was also possible an accurate differential diagnosis, with simplification of diagnostic and therapeutic path for patients, minimizing urgent surgical therapy and improper hospitalization. Finally, this kind of organization allows accurate data collection and database creation with improve of the scientific research.

Study of Differentiated Beta-Human Chorionic Gonadotropin Serum (BhCG), Progesterone and CA-125 in Patients with Tubal Ectopic Pregnancy

Ectopic pregnancy (EP) is 6-10% of all pregnancy related deaths. The incidence of EP is 1-2% in the developed countries. In the present study we evaluated the serum BhCG, progesterone and CA-125 level in the efficacy of methotrexate for treatment of ectopic tubal pregnancy. Over a period of two years, 61 patients with the diagnosis of ectopic pregnancy included in study. 30 cases were in methotrexate (MTX) treatment group and 31 cases in surgical treatment group. Sera of samples were assayed for BhCG, progesterone and CA-125. Analyses were performed using SPSS version 16 computer software. T-test and chi square, Roc analysis was used for Sensitivity and specifity. Mean of baseline BhCG level at initial presentation was 439±363 in MTX group and 1027±722 in surgical treatment group; These levels in two groups were significantly different (p=0.001). Mean of initial serum progesterone level was significantly higher in surgical treatment group than medical treatment group (p<0.006). In addition, no statistically difference was observed in CA-125 between two groups (p<0.671). Finding of this study showed that pretreatment serum BhCG and progesterone level had meaningful relation with the efficacy of medical treatment of ectopic pregnancy; Also in this study CA-125 was not a predictor of MTX treatment.

Single dose methotrexate for the treatment of unruptured ectopic pregnancy: experience in Kemaman Hospital, Terengganu, Malaysia

Background: The objective of this study was to review our experience with single dose intramuscular methotrexate (MTX) for the treatment of ectopic pregnancy and to evaluate the safety and efficacy of the treatment modality. Methods: A prospective study was carried out at Kemaman Hospital, Terengganu, Malaysia. A database was started and continued prospectively for patients meeting all the criteria’s for MTX therapy from January 2015 till January 2016. The selection criteria’s were patients who were asymptomatic or experience mild symptoms but haemodynamically stable and ectopic gestational mass of less than 4cm on ultrasound. Intramuscular methotrexate (MTX) 50mg/m2 was administered as in-patient and monitored at least 24 hours for side effects. Upon discharge, blood samples were collected on day 4 and day 7 of MTX therapy and weekly to 2-weekly thereafter until hCG titers became < 2mIU/mL. Results: 4 patients opted for medical treatment. All patients received only a single dose methotrexate and did not have complications post medical treatment. hCG level reached normalization within 30 days and 1 patient had longer follow up until 120 days. Higher patient satisfaction in all patients due to the noninvasive nature of the treatment modality. Conclusions: This study showed that medical treatment of ectopic pregnancy with systemic single dose methotrexate can be a primary treatment modality for selected patients with stable unruptured tubal pregnancy.