Methotrexate in Interstitial Pregnancy: A Miraculous Fertility Rescuer (original) (raw)
Related papers
Frontiers in Endocrinology, 2018
Ectopic pregnancy (EP) is the implantation of an embryo outside the endometrial cavity of the uterus. Signs and symptoms of EP may arise between the 6th and the 8th week of gestation and include vaginal bleeding, lower abdominal and pelvic pain. Frequently EPs implant in the fallopian tubes. A rare EP is the interstitial pregnancy, a life-threatening condition being responsible for nearly 20% of all deaths caused by EPs. Because of its unique location, the diagnosis is difficult and based on signs and specific criteria together with measuring of serum β-hCG. Usually, EP is treated by surgical approach, which is associated with increased morbidity, decreased fertility and increased likelihood of hysterectomy and uterine rupture in a subsequent pregnancy. Early diagnosis is crucial to life saving and allowing alternative therapeutic interventions such as pharmacological treatments. Methotrexate (MTX) represents the mainstay therapy. There is no standard care for the interstitial pregnancy for what concerns either surgical or pharmacological approaches. We reported a case of a 36-year-old woman admitted to the Hospital of Salerno-Italy with a value of serum β-hCG of 35,993 IU/L. Transvaginal ultrasonography revealed an empty uterine cavity and a mass of 35.7 mm in diameter characterized by a hypoechoic central area. The patient was in stable haemodynamic condition and no haematologic, renal and hepatic impairments were recorded. Despite the high serum β-hCG levels, a pharmacological approach was preferred to a surgical one. The patient was treated with intramuscular administration of MTX in daily dose of 1 mg/Kg alternated with 0.1 mg/kg folinic acid for 5 days. The patient remained hospitalized for 20 days and no side effects were reported. The decrease of the serum β-hCG was monitored and more than 15% reduction was detected between the 4th and the 7th day after the beginning of the treatment. The serum β-hCG became undetectable 35 days after. A multidosing intramuscular administration of MTX was effective and safe even in the presence of very high serum β-hCG levels. Together with similar cases reported in literature, the present results can contribute to improve the decision making in the treatment of the interstitial pregnancy.
Transvaginal intratubal methotrexate treatment of ectopic pregnancy. Report of 100 cases
Human Reproduction, 1996
patients with a common, unruptured ectopic pregnancy were treated with 1 mg/kg injection of intratubal methotrexate under transvaginal sonographic control. Patients were not excluded from this series on the basis of the size of the adnexal mass, the term of ectopic pregnancy or initial p-human chorionic gonadotrophin (HCG) concentrations. Patients were excluded following uncertain diagnosis, signs of a ruptured ectopic pregnancy, or a significant haemoperitoneum on ultrasound scans. The mean age of the patients was 29.5 years (range 20-41). The mean gestational age and initial HCG concentration were 7.5 weeks (5-11) and 11 614 mlU/ml (192-105 000 respectively). Of the 100 patients, 22 (22%) had an ectopic pregnancy with active cardiac activity. Complete resolution was obtained in 78 out of these 100 ectopic pregnancies. Of these, 66 patients (85%) needed only one intratubal methotrexate injection, and 12 patients (15%) required a second i.m. methotrexate injection of 1 mg/kg. In this study, local treatment with one single intratubal methotrexate injection was successful in only 66% of patients. The mean resolution time for reduction of p-HCG concentrations was 23.5 days (range 7-40). There was no statistically significant correlation between initial (J-HCG concentrations and outcomes after methotrexate treatment of ectopic pregnancy in our study. Where embryonal heart beats were observed, the success rate of the procedure was 40.9% (nine out of 22 cases). In the absence of cardiac activity, or when ultrasound examination showed no embryo, the success rate achieved was 84.6% (66 out of 78 cases) (P < 0.01). In all, 34 patients were considered to be incompletely cured after only one intratubal methotrexate injection: 12 patients required a second i.m. injection, a stagnation of {i-HCG concentrations was observed in 15 patients, abdominal pain occurred in six patients, and one patient suffered tubal rupture with haemoperitoneum. A total of 22 patients required secondary surgical managment (salpingectomy). No biochemical or clinical side-effects of methotrexate treatment occurred. Tubal alteration ascribable to methotrexate injection occurred in one patient in our study. Out of 75 patients in this series who wished to conceive, 21 (28%) became pregnant within 1 year with the following 420 outcomes: 11 pregnancies at term, three miscarriages, one induced abortion and six recurrent ectopic pregnancies (four occurred on the same side). Our findings suggest that treatment of common unruptured ectopic pregnancy without prior selection of patients, by a single intratubal methotrexate administration was associated with a 66% success rate. This was dependent only on the presence of embryonal heart beats and there was no correlation between the success rate and initial fi-HCG concentrations. Successful outcome after methotrexate administration for ectopic pregnancy could be perfected by way of an improved selection of patients based on inactive embryonal hearts and absence of a visualized embryo.
Treatment of ectopic pregnancy with methotrexate
Acta clinica Croatica, 2012
The aim of the present study was to analyze retrospectively the safety and success rates of single- and two-dose methotrexate (MTX) protocols for the treatment of hemodynamically stable cases of ectopic pregnancy at University Department of Gynecology and Obstetrics, Zagreb University Hospital Center, during a five-year period. The study evaluated MTX treatment efficacy in 35 women with ectopic pregnancies in relation to the initial levels of human chorionic gonadotropin (hCG) and progesterone. Successful treatment was recorded in 32/35 women, 24/25 on single dose MTX and 8/10 on double dose MTX, whereas 3/35 patients underwent laparoscopy. The mean initial hCG level in all 35 patients on day 0 was 657.54 +/- 592.4 IU/L; 572.99 +/- 488.10 IU/L in those successfully treated with MTX and 1560.30 +/- 890.70 IU/L in those requiring additional laparoscopy (p < 0.005). The mean initial hCG level was 393.10 +/- 305.9 IU/L in patients successfully treated with a single dose of MTX and 97...
Interstitial pregnancy treated with a single-dose of systemic methotrexate: A successful management
2015
Interstitial pregnancy is an ectopic pregnancy at high hemorrhagic risk. It often poses a diagnostic and therapeutic challenge to the clinician, with a significant risk of morbidity and mortality. It presents a difficult management problem with no absolute standard of care; the most appropriate treatment technique for these pregnancies remains controversial. We describe a case of unruptured interstitial pregnancy successfully treated with a single-dose of systemic methotrexate with subsequent ultrasound and serum beta human chorionic gonadotropin monitoring. Medical management can be a safe and successful option in selected cases that satisfy specific criteria and in women who are able to be monitored after treatment.
Medical Management of Ectopic Pregnancy using Methotrexate
The Internet Journal of Gynecology and Obstetrics, 2007
Background: Medical treatment of the ectopic pregnancy with methotrexate has been considered an alternative to surgical intervention. Aims & Objectives: 1) To review adherence to guidelines for the medical management of ectopic pregnancy 2) To determine: a) diagnostic investigations. b) Suitability for Methotrexate treatment c) Initial investigations 3) To ascertain: a) follow-up investigations b) outcome Methods:A retrospective study from January 2002-May 2006 was carried out, collecting clinical imaging data and serum betahuman chorionic gonadotrophin (βhCG). Time taken for complete βhCG resolution was recorded, and a negative βhCG result was used as an endpoint of successful outcome. Results: Of the 17 cases, where Methotrexate (50mg I.M) was used, three required surgery for symptoms of rupture. In the remaining 14 cases, there were no side-effects, complete βhCG resolution was achieved in 13 of the 14 medically treated cases (91% success rate), with in 28 days. Conclusion: Methotrexate used as treatment is safe and effective for unruptured ectopic pregnancies that satisfy the strict criteria with no side-effects and the advantage of avoiding invasive surgery. Subsequent tubal patency and reproductive functions were comparable to the surgery.
Safety and Efficacy of Methotrexate In Unruptured Ectopic Pregnancy
Bangladesh Journal of Obstetrics & Gynaecology, 2016
Introduction: Medical management of an unruptured ectopic pregnancy with intramuscular methotrexate is a common and cost-effective alternative to surgery 1. This therapeutic transition from surgical emergency to medical management has been attributed to early diagnosis through the use of sensitive assays for β-hCG and the high definition vaginal ultrasound. Objectives: The aim of the study was to observe the efficacy and safety of medical treatment either by a single or multiple dose of methotrexate to cure ectopic pregnancy. Materials and methods: A retrospective study from January 2005-June 2008 was carried out, collecting clinical imaging data and serum β-hCG, time taken for complete β-hCG resolution was recorded and negative β-hCG result was used as an endpoint of successful outcome. Out of 14 cases, where Methotrexate (50 mg I/M) was used, two required surgery for symptom of rupture. In the remaining 12 cases, there was no side effects, complete β-hCG resolution was achieved in 10 of the12 medically treated cases (85% success rate) within 28 days. Rest of the 2 cases needed multiple doses of Methotrexate. Results: Over all success rate was 85%. In 71% cases recovery was uneventful and complete within 7 days of treatment (Table 1). Two patients needed surgical treatment and in another one case there was abdominal pain which subsided after analgesic. Ten patients were cured by single dose only and 2 patients needed multiple dose. There was no side effects or complication of drug in any case. Conclusion: Methotrexate is safe and effective for unruptured ectopic pregnancies that satisfy the strict criteria with no side effects and the advantage of avoiding invasive surgery. This small trial gave a good impression about medical treatment in selective cases.
Single Dose Methotrexate In Treatment Of Ectopic Pregnancy: Review Of 32 Cases
Medical Journal of Trakya University, 2009
Objective: To evaluate the efficacy of single dose intramuscular methotrexate in the treatment of ectopic pregnancy. Material and Methods: 32 patients who matched the inclusion criteria were enrolled. Success of treatment was defined as a resolution of ectopic pregnancy without performing surgical intervention. The cases in whom the treatment was successful and those that were not were compared for β-hCG values and clinical features. Results: β-hCG at diagnosis averaged 1293.9 mIU/ml. Of the 32 patients who received methotrexate, 26 were successfully treated. 23 patients (71.8%) received a single dose of methotrexate, 3 patients (9.3%) received an additional dose of methotrexate, 6 patients (18.7%) who had failed methotrexate required surgery for cure. The success rate of single-dose methotrexate was 79.3%. Conclusion: Our study shows that single dose systemic methotrexate treatment can be used as an option in unruptured pregnancies.
International Journal of Women's Health
Objective: To study factors associated with the success of single dose methotrexate (MTX) treatment in women with ectopic pregnancy. Methods: This is a retrospective study of women (n=110) with ectopic pregnancy and treated with single dose of MTX. The clinical presentations, transvaginal sonography (TVS) findings, pretreatment beta-human chorionic gonadotropin (β-HCG), and progesterone values were compared between the treatment success (Group S) and treatment failure (Group F) groups. Results: The overall success rate of treatment with single dose of MTX was 75.45%. The majority of patients in both groups presented with pain and bleeding (~55%), and bleeding only was the presenting symptom in about 20% of patients. Only 3 patients (3.61%) in Group S required a repeat dose of MTX. In contrast, 51.8% of the Group F patients required a repeat dose. The mean pretreatment β-HCG level was 2.3 times higher in Group F than in Group S (1734±1684 vs 4036±2940 IU/L). The data showed a β-HCG level of 3924IU/L as a suitable cutoff value with 76.19% sensitivity and 62.5% specificity to predict MTX treatment success. History of ectopic pregnancy had no relation with success/treatment failure or a repeat dose. None of the TVS findings were related to the outcome of the treatment, whereas pretreatment HCG level was a significant predictor. Conclusion: The single dose MTX treatment was successful in 75.45% (83/110) of cases, with 3.61% (3/83) requiring a repeat dose of the drug. Pretreatment β-HCG level is a significant predictor of the treatment outcome.
Background: Medical treatment of ectopic pregnancy with methotrexate has been considered as an alternative to surgical intervention. Aims and objectives: The present was carried with an aim to determine the role of methotrexate in management of ectopic pregnancy. Materials and methods: The present study was carried out for a period of 5 years (September 2007 to August 2012) in a tertiary care hospital. It included a total of 128 patients of unruptured ectopic pregnancies. The medical management was done with methotrexate. Time taken for complete β human chorionic gonadotrophin (β hCG) resolution was recorded. The negative β hCG result indicated as an endpoint of successful outcome. Results: Out of 128 cases where Methotrexate was used, 4 required surgery. In remaining 124 cases, there were no side effects. Complete β hCG resolution was achieved in 28 -35 days. Subsequent tubal patency & reproductive functions were comparable to that of surgical management. Conclusion: From our study, it can be concluded that methotrexate can be recommended as safe and effective drug for management of unruptured ectopic pregnancies.
Methotrexate for ectopic pregnancy: when and how
Archives of Gynecology and Obstetrics, 2014
protocols which exhibit a greater number of studies are still based on the single-dose treatment. Conclusion Considering MTX, it proved to be more effective in cases of low titers of beta-hCG and masses with a small diameter, although there is still no uniformity of these parameters. The choice largely depends on the experience of the medical team and ultimately, on the woman's reproductive desire. Keywords ectopic pregnancy • Methotrexate • Therapeutic • Reproductive health The most frequent location and the main focus of this article is the tubal ectopic pregnancy [16]. Other localizations of atypical ectopic pregnancies include: the cervix (0.15 %), the ovary (0.15-3 %), the abdomen (1.3 %), the