A Review of the Literature on Nonsurgical Treatment in Tubal Pregnancies

Kooi, Sjarlot; Kock, H.C.L.V.

doi:10.1097/00006254-199211000-00001

Cited by 53 publications

(20 citation statements)

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“…4 In our study, we selected patients whose Sr. ß-hCG were < 5000 IU. Because Stroel and Liing 5 and Lipscomb et al 3 found that the presence of cardiac activity within the ectopic pregnancy reduced the success rate from 95% to 70%. We excluded ectopic pregnancies with a positive cardiac activity.…”

Section: Discussionmentioning

confidence: 99%

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Knifeless Management of Early Ectopic Pregnancy

Dutta¹,

Chattopadhyay²,

Das³

et al. 2017

jemds

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Section: Discussionmentioning

confidence: 99%

“…Systemic Mtx was first recognised as medical treatment for unruptured EP by Tanaka et al in 1982, 3 and since then it is popularised as a safe and effective medical management alternative to surgery.…”

Section: Introductionmentioning

confidence: 99%

Knifeless Management of Early Ectopic Pregnancy

Dutta¹,

Chattopadhyay²,

Das³

et al. 2017

jemds

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“…The use of methotrexate to treat ectopic pregnancy is particularly attractive in patients who may be high surgical risks, such as cases of cornual pregnancy, incomplete resolution of surgically treated ectopic gestation, patients with gonadotropin‐induced ovarian hyperstimulation syndrome, or patients suspected of having extensive intraperitoneal abdominal adhesions 74…”

Section: Treatmentmentioning

confidence: 99%

Ectopic Pregnancy

Luciano

Roy

Solima

2001

Annals of the New York Academy of Sciences

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During the past 25 years, the incidence of ectopic pregnancy has progressively increased while the morbidity and mortality have substantially decreased, and the treatment has progressed from salpingectomy by laparotomy to conservative surgery by laparoscopy and more recently to medical therapy. This therapeutic transition from surgical emergency to medical management has been attributed to early diagnosis through the use of sensitive assays for hCG and the high definition of vaginal ultrasound. By using these sensitive diagnostic tools, we are now able to select those patients who are most likely to respond to medical management versus those who are at high risk of rupture and require surgery. Besides being less invasive and associated with significantly lower risks, medical therapy with methotrexate results in significant cost savings, which have been calculated to be approximately $3,000 per treated patient. Our goal is to identify those patients with ectopic pregnancy who are most likely to respond to methotrexate therapy and least likely to develop significant side effects. Recent studies have helped us define the predictors of success with methotrexate treatment in women with ectopic pregnancy. The reported success rates of treating ectopic pregnancy with methotrexate vary from 71% to 100%. The highest success rates have been reported from institutions that have detailed diagnostic and therapeutic protocols, readily available assays for serum hCG levels, high-resolution vaginal probe ultrasound, and support staff that can closely monitor clinical response. The importance of developing specific protocols to create a clinical environment that supports the effective use of medical therapy for ectopic pregnancy is confirmed by the associated cost savings, decreased morbidity, and patient preference. Modern diagnostic advances and minimally invasive treatments coupled with improved success rates for assisted reproductive technologies should reduce the morbidity and mortality associated with ectopic pregnancy and offer the affected couple a much more optimistic outlook for subsequent reproductive potential.

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“…None of the reported studies so far had suggested the initial serum bhCG concentration as being an exclusion criterion for methotrexate therapy, but Kooi & Kock, 24 from their extensive review, found that the incidence of tubal rupture is 32% if the initial serum bhCG level is greater than 10 000mIU/ml, and 3% if the bhCG level is less than 10 000mIU/ml. It is still controversial whether an ectopic gestation found to have cardiac activity on ultrasound should be excluded from methotrexate treatment.…”

Section: Patient Selectionmentioning

confidence: 99%

Current status of management of ectopic pregnancy

Auld

1999

Gynaecol Endoscopy

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Objective To evaluate the relative safety and efficacy of conservative surgical, medical and expectant management. Design Relevant studies were identified through a computer Medline search. Results Laparoscopy is not mandatory for diagnosis of ectopic pregnancy, which can be diagnosed by the use of transvaginal scan and estimation of quantitative βhCG. Laparoscopic salpingectomy or salpingostomy is preferred to laparotomy in a haemodynamically stable patient and should be used more frequently. The role of expectant management in ectopic pregnancy is very limited. Spontaneous resolution may occur only in a selected group of unruptured ectopic pregnancies with an initial βhCG of <200 mIU/ml and declining hCG level. Systemic methotrexate administration is a promising treatment in patients with early and unruptured ectopic pregnancy. Several prospective studies have shown success rates of 85–94% following single‐dose systemic methotrexate treatment. Single‐dose methotrexate is associated with fewer side‐effects but is as effective as multiple‐dose regimes. Recurrent ectopic pregnancy and intrauterine pregnancy rates following systemic methotrexate are comparable to those following laparoscopic salpingostomy. Conclusion Systemic methotrexate is a viable alternative to laparoscopic salpingostomy for women wishing to preserve their fertility. A large prospective randomized trial is needed to establish whether laparoscopic surgery or methotrexate should be the first‐line treatment.

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A Review of the Literature on Nonsurgical Treatment in Tubal Pregnancies

Cited by 53 publications

References 0 publications

Knifeless Management of Early Ectopic Pregnancy

Knifeless Management of Early Ectopic Pregnancy

Ectopic Pregnancy

Current status of management of ectopic pregnancy

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