Efficacy of In Situ Methotrexate Injection in the Treatment of Nontubal Ectopic Pregnancies: A Retrospective Multicenter Study

Abstract

This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Interstitial pregnancy management: A multicentric analysis of 98 patients from the FRANCOGENT group comparing surgery and medical treatment

“…when comparing IM‐MTX versus IS‐MTX to treat non‐tubal ectopic pregnancies. In their experience, the primary success rate of treatment was significantly correlated to the IS‐MTX, either solely or in conjunction with an IM‐MTX administered the following day with an odds ratio of 2.7 (95% CI: 1.03–7.14) 15 . The higher success rate of IS‐MTX could be explained by the method used for injection.…”

An update and review of nontubal ectopic pregnancy management

“…Combination therapy of systemic methotrexate and local injection significantly increases success rates up to 77% [16,17 ▪ ]. There is wide variation in reported dosages for local injection of methotrexate including 1 mg/kg, 50–75 mg/m 2 , and nonadjusted doses of 12.5–100 mg, in 2–5 ml injectable solutions [18].…”

“…Medical management combined with local injections has several advantages including avoidance of surgery, decreased risk of hemorrhage, outpatient follow-up, and is generally tolerated well [17 ▪ ,19,20]. However, patients must be thoroughly counseled regarding the risks of methotrexate treatment and must agree to close, frequent, and prolonged follow-up.…”

Tratamiento del embarazo ectópico implantado en cicatriz de cesárea: estudio de cohorte 2018-2022, Lima, Perú

“…Respecto del manejo médico, este se realiza con metotrexato (MTX), existiendo una controversia respecto del uso de esquemas de dosis única 11 , múltiple 12 , o como inyección local dentro del saco gestacional 13 . Por ejemplo, Herondelle et al, al estudiar a pacientes con embarazo en cicatriz, en el istmo, intersticiales o cervicales, prescribieron MTX sistémico a 27 pacientes, inyección local a 21, y una combinación de ambas a 8, encontrando una tasa de éxito del 46,6, 60 y 61,5 %, respectivamente, por cuanto recomendaron el tratamiento local 13 .…”

“…Respecto del manejo médico, este se realiza con metotrexato (MTX), existiendo una controversia respecto del uso de esquemas de dosis única 11 , múltiple 12 , o como inyección local dentro del saco gestacional 13 . Por ejemplo, Herondelle et al, al estudiar a pacientes con embarazo en cicatriz, en el istmo, intersticiales o cervicales, prescribieron MTX sistémico a 27 pacientes, inyección local a 21, y una combinación de ambas a 8, encontrando una tasa de éxito del 46,6, 60 y 61,5 %, respectivamente, por cuanto recomendaron el tratamiento local 13 . Por otra parte, Peng et al, en un estudio randomizado con 52 pacientes con CSP en cada brazo, para comparar el tratamiento sistémico vs. el local, encontraron una tasa de curación general similar (67,3 y 69,2 %, respectivamente; p > 0,05); aunque, la remisión de la β-hCG fue significativamente más rápida después de la administración sistémica (p = 0,029) 14 .…”