Medical treatment of ectopic pregnancy
Keywords:
Ectopic pregnancy, medical treatment, MethotrexateAbstract
Background: The ectopic pregnancy (EP) is a public health problem and its frequency has doubled in most industrialized countries in 20 years.aim: To evaluate the effectiveness of medical treatment of ectopic pregnancy with methotrexate (MTX) intramuscularly (IM).
methods: prospective study supported between October 2006 and December 2010. The selected patients received methotrexate IM (1 mg per kg). The monitoring was based on: the kinetics of plasma HCG, clinical examination and ultrasound. A second injection was performed if hCG on day 4 was increased by more than 25% or J7> the initial rate. Healing corresponded to obtain a zero rate of HCG in a stable manner.
results:We used the first-line medical treatment in 122 patients. The average age of patients was 31.94 years. A haematosalpinx was found in 87.70% of cases. The initial rate of HCG plasma varied between 40 IU/ml and 4088 IU / ml, with an average of 805.88 m IU / ml. The primary success rate obtained after a single injection of intramuscular MTX was 67%. The high success rate obtained after two injections of MTX was 27%. The overall success rate after 1 or 2 injections of MTX was 82%. 17 patients underwent surgical treatment after a first injection of methotrexate. 5 patients underwent surgery after receiving two doses of methotrexate. The period of normalization of plasma levels of h CG was 24 days on average, with extremes ranging from 4 to 43 days for 67 patients cured after a single injection of MTX. This period was 33 days on average, with extremes ranging from 8 to 62 days for patients healed after two injections of MTX.
Conclusion: Medical treatment applied to 38% of ectopic pregnancies diagnosed in our department is effective in 82% of cases if the inclusion criteria are strictly adhered to. Successful treatment is limited by patient compliance and demanding nature of monitoring.
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References
Tanaka T, Hayashi H, Kutsuzawa T. Treatment of interstitial ectopic pregnancy with methotrexate: report of a successful case. Fertil Steril 1982; 37: 851-2
Garbin O, De Tayrac R, Fernandez H et al. Le méthotrexate dans le traitement médical des grossesses extra utérines non rompues. J Gynecol Obstet Biol Reprod 2004 ;32 :420-5.
Hajenius PJ, Engelsbel S, Mol BW et al. Randomised trial os systemic methotrexate versus laparoscopic salpingotomy in tubal pregnancy. Lancet 1997;350:774-9.
Canis M, Savary D, Pouly JL et al. Grossesse extra-utérine : critères de choix du traitement médical ou du traitement chirurgical. J Gynecol Obstet Biol Reprod 2003;32:54-63.
Fernandez H, Pauthier S, Doumerc S et al. Ultrasound-guided injection of methotrexate versus laparoscopic salpingotomy in ectopic pregnancy. Fertil Steril 1995;63:25-9.
Vaissade L, Gerbaud L, Pouly JL et al. Comparaison coût-effectivité de la coeliochirurgie versus le traitement médical au méthotrexate à partir du registre des grossesses extra-utérines d'Auvergne. J Gynecol Obstet Biol Reprod 2003;32:447-58.
Goffinet F, Dreyfus M, Madelenat P. Recommandations pour la pratique clinique : prise en charge de la grossesse extrautérine. Gynecol Obstet Fertil 2004;32:180-5.
Spandorfer SD, Sawin SW, Benjamin I et al. Postoperative day 1 serum gonadotrophin level as a predictor of persistent ectopic pregnancy after conservative surgical management. Fertil Steril 1997;68:430-4.
Jourdain O, Fontanges M, Schiano A et al. Prise en charges des autres ectopies annexielles (cornuale, interstitielle, angulaire, ovarienne). J Gynecol Obstet Biol Reprod 2003;32:93-100.
Hajenius PJ, Engelsbel S, Mol BW et al. Randomised trial os systemic methotrexate versus laparoscopic salpingotomy in tubal pregnancy. Lancet 1997;350:774-9.
Lipscomb GH, McCord ML, Stovall TG et al. Predictors of success of Methotrexate treatment in women with tubal ectopic pregnancies. N Engl J Med 1999;341:1974-8.
Cassik P, Ofili-Yebovi D, Yazbek J et al. Factors influencing the success of conservative treatment of interstitial pregnancy. Ultrasound Obstet Gynecol 2005;26:279-82.
Carson SA, Buster JE. Ectopic pregnancy. N Engl J Med 1993;329:1174-81.
Lipscomb GH, Mc Cord ML, Stovall TG et al. Predictors of success of methotrexate treatment in women with tubal ectopic pregnancies. N Engl J Med 1999;341:1974-8.
Milad MP, Klein E, Kazer RR. Preoperative serum HCG level and intraoperative failure of laparoscopic linear salpingostomy for ectopic pregnancy. Obstet Gynecol 1998;92:373-6.
Gazvani MR, Baruah DN, Alfirevic Z et al. Mifepristone in combinaison with methotrexate for the medical treatment of tubal pregnancy: a randomized controlled trial. Hum Reprod 1998;13:1987-90.
Lipscomb GH, Bran D, Mc Cord LM et al. Analysis of three hundred fifteen ectopic pregnancies treated with single-dose MTX. Am J Obstet Gynecol 1998;1178:1354-8.
