Conservative Management of Ectopic Pregnancy with Fetal Cardiac Activity by Combined Local (Sonographically Guided) and Systemic Injection of Methotrexate

Abstract

Objective: To evaluate the efficacy of conservative management of ectopic pregnancy with fetal cardiac activity by combined local sonographically guided and systemic injection of methotrexate. Study Design: The study group included 12 patients with ectopic pregnancy and fetal cardiac activity, treated by combined local and systemic injection of methotrexate in the period from January 1, 2000 to July 1, 2002. The outcome of these patients was compared with the outcome of 53 patients who had ectopic pregnancy without fetal cardiac activity and were being treated only by systemic injection of methotrexate during the same period of time. Results: The success rate was 91.6% (11 out of 12) in the group of patients with ectopic fetal cardiac activity and 90.5% (48 out of 53) in the group of patients with ectopic pregnancy, but without fetal cardiac activity. There was also no significant difference between the two groups comparing the percentage of cases treated by an additional dose of methotrexate (8.3 and 13.2%, respectively), nor comparing the number of days to resolution of β-human chorionic gonadotrophin (BHCG; 40 ± 2 and 34 ± 10 days, respectively). Conversely, there was a significant difference in the initial BHCG level comparing the group of patients treated by combined local and systemic injection of methotrexate (12,616 ± 9,585 mIU/ml) and the group of patients treated by systemic injection of methotrexate (1,499 ± 2,065 mIU/ml) (p < 0.00001). Seventy-five percent of patients (6 out of 8) diagnosed with ectopic fetal cardiac activity, who desired to become pregnant, succeeded to conceive within 6 months following the combined local and systemic injection of methotrexate. Conclusion: The combined local sonographically guided and systemic injection of methotrexate is associated with a successful outcome in asymptomatic patients presenting with ectopic pregnancy and fetal cardiac activity.

The efficacy and safety of managing ectopic pregnancies with transvaginal ultrasound-guided local injections of absolute ethanol

“…The patients can be informed of the effect of the treatment 3 h after the procedure, including one hour for gaining the blood test result, and then can go home. The success rate, although it varies in the literature, proved to be equal to or more promising than that of MTX injection [3][4][5][6][7]. The aim of AE injection is to dehydrate and destroy chorionic villi.…”

“…The success rate of treating EP with MTX is 70-95% [3][4][5][6][7], and laparoscopic treatment is necessary for failed cases. By comparison, although the failure rate with AE injection is 13%, it leaves two options for treating failed cases, i.e.…”

“…3 Department of Obstetrics and Gynaecology, School of Medicine, Nihon University, Japan. 4 To whom correspondence should be addressed at Kato Ladies Clinic, Shinjuku-ku, Tokyo, Japan; e-mail: h-kaijima@towako-kato.com.…”

Management of Caesarean Scar Pregnancies Using an Intrauterine or Abdominal Approach Based on the Myometrial Thickness between the Gestational Mass and the Bladder Wall

“…Termination of pregnancy is recommended soon after confirmation of a CSP to avoid catastrophic complications, such as uterine rupture and heavy bleeding. Proposed interventions for CSPs include medical (feticide with systemic or local administration of methotrexate; MTX) [2] and surgical intervention (dilatation and curettage (D&C), hysteroscopy, laparoscopy, laparotomy, or hysterectomy) [3]. Recently, uterine artery embolization (UAE) has been suggested as an alternative to systemic administration of MTX [4].…”

Clinical Effectiveness of Multiple-Drug Injection Treatment in Unruptured Ectopic Pregnancies

“…In recent years, several studies reported that local methotrexate injection under transvaginal color Doppler sonographic guidance has showed good therapeutic effects in stable unruptured ectopic pregnancy cases. 13,28,29 Yao and Tulandi 30 reported that the success rate of treating ectopic pregnancies with local methotrexate injection under transvaginal sonographic guidance was 70% to 95%. Among the 23 patients in our study treated Data are presented as number (percent) and mean ± SD (range).…”