Multidose Methotrexate Treatment of Ectopic Pregnancies with High initial β-Human Chorionic Gonadotropin: Can Success Be Predicted?

Tuğ, Niyazi; Sargın, Mehmet; Yassa, Murat

doi:10.1159/000491083

Cited by 8 publications

(8 citation statements)

References 14 publications

(27 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Using a multidose MTX regimen, Tug et al observed that BMI, MTX dose, number of MTX injections and the decrement of β-HCG levels highly predictive for the success of the treatment. 22 An elevated initial β-HCG level is considered as the most important factor associated with treatment failure. The mean pretreatment β-HCG level for all patients in this study was 2016±2241IU/L, and the mean pretreatment level was 2.3 times higher in the failure group (4036±2940 vs 1734±1684 IU/L).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The Use of Single Dose Methotrexate in the Management of Ectopic Pregnancy and Pregnancy of Unknown Location: 10 Years’ Experience in a Tertiary Center

Sindiani¹,

Alshdaifat²,

Obeidat³

et al. 2020

IJWH

View full text Add to dashboard Cite

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 cut-off 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.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Using a multidose MTX regimen, Tug et al observed that BMI, MTX dose, number of MTX injections and the decrement of β-HCG levels highly predictive for the success of the treatment. 22 …”

Section: Discussionmentioning

confidence: 99%

The Use of Single Dose Methotrexate in the Management of Ectopic Pregnancy and Pregnancy of Unknown Location: 10 Years’ Experience in a Tertiary Center

Sindiani¹,

Alshdaifat²,

Obeidat³

et al. 2020

IJWH

View full text Add to dashboard Cite

show abstract

“…Methotrexate has been used in ectopic pregnancy [17] and to aid resorption of unresectable advanced extrauterine placentae. In advanced extra-uterine pregnancy, the variability of placental attachments calls for individualized decision-making and improvisation.…”

Section: Discussionmentioning

confidence: 99%

Foley Catheter Tourniquet for Uncontrollable Extra-Uterine Placental Hemorrhage: Description of a Novel Surgical Technique

Hofmeyr

Majeke

Nassali

2021

Gynecol Obstet Invest

View full text Add to dashboard Cite

Introduction Hemorrhage from a partially or fully detached placenta with an advanced abdominal pregnancy can be profuse and catastrophic. The general approach to placenta management is removal of “all or nothing’’. In the event of acute hemorrhage, every attempt to achieve hemostasis quickly is critical. The Foley catheter has shown utility when used to control placental hemorrhage or as a temporary tourniquet applied around structures surrounding the implantation site to aid placental removal with minimal hemorrhage. We report use of the technique on four occasions with good surgical outcomes. Case Presentation We report a case of a 33 year-old primigravida admitted at term with an ultrasound diagnosis of breech presentation and placenta previa grade four. Her pre-operative clinical assessment however, raised suspicion of an abdominal pregnancy. At laparotomy, a live female infant was delivered from the extra-uterine gestation sac, weighing 3640g and with an Apgar score of 7 and 6 at one and 5 minutes respectively. Following delivery, there was profuse bleeding from the partially detached distal portion of the placenta that derived rich blood supply from the poorly accessible posterior pelvic wall. We applied a novel, simple and effective surgical technique for minimizing blood loss from the partially detached placenta using a Foley’s catheter tourniquet that was applied between the detached and still attached parts of the placenta. The tourniquet was left in situ and removed at laparotomy 4 days later. The placenta was not removed. The mother and baby did well postoperatively and were discharged after 10 and 21 days respectively in good condition. The surgical technique was similarly used in 3 additional cases with good clinical outcomes. Discussion Use of a Foley catheter as an intraoperative tourniquet has become accepted as a useful technique in obstetric and gynecological surgery. We describe a simple life saving technique of applying a Foley tourniquet across a partially detached placenta following an advanced extra-uterine pregnancy to control acute hemorrhage. Conclusion We recommend that surgeons keep in mind the option of intraoperative tourniquets when faced with uncontrollable bleeding as a short-term or medium-term temporizing measure.

show abstract

“…On day 3, blood results were as follows: WBC 4.150/μL, Hb 14.2 g/dL, β-hCG 4.165 IU/L. According to the hospital guidelines [ [1] , [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] ], since β-hCG serum levels had not declined by more than 15%, the treatment continued in the same way. The patient received three more doses of MTX 100 mg on days 3, 5 and 7 and every dose was followed by administration of folinic acid 10 mg, on days 4, 6 and 8.…”

Section: Case Presentationmentioning

confidence: 99%

“…Methotrexate (MTX) can be administered via a single, double or multiple injections. Multiple-dose MTX treatment of cornual ectopic pregnancies appears to be a safe and effective method, but the success of the therapy depends strongly on body mass index, MTX dose, number of MTX injections and a decrease in β-hCG levels [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

Multidose methotrexate treatment of cornual pregnancy after in vitro fertilization: Two case reports

Loukopoulos

Zikopoulos

Mastora

et al. 2022

Case Reports in Women's Health

View full text Add to dashboard Cite

Background An ectopic pregnancy, when the gestational sac is implanted outside of the uterine cavity, can be life-threatening. A cornual pregnancy is the most dangerous type of ectopic pregnancy since it can be misdiagnosed easily and has high mortality rate. It is diagnosed when the implantation site is at the junction between the fallopian tube and the uterus. For a successful outcome, early diagnosis and management are critical. The traditional management is surgical, involving cornual resection or hysterectomy, which, however, affects fertility. Thus, conservative management involving administration of methotrexate should always be considered. Case presentation The article describes to two women in their early forties with no previous children (G1, P0) and diagnosed with a cornual pregnancy at 7 and 8 weeks of gestation following in vitro fertilization. Given their hemodynamic stability and their desire to conserve fertility they were treated conservatively. The two patients had similar ultrasound findings and blood results. The main difference was the presence of an embryonic heart beat in one case. Successful management was accomplished with multidose methotrexate and leucovorin during hospitalization for 8 days and close monitoring for the next 30 days as outpatients. In addition, the second woman was given a transvaginal injection of potassium chloride (KCL) to stop embryonic cardiac activity. Conclusion Conservative management of cornual pregnancies applying multidose therapy of methotrexate and leucovorin is a safe treatment when patients are asymptomatic and preserves fertility.

show abstract

Multidose Methotrexate Treatment of Ectopic Pregnancies with High initial β-Human Chorionic Gonadotropin: Can Success Be Predicted?

Cited by 8 publications

References 14 publications

The Use of Single Dose Methotrexate in the Management of Ectopic Pregnancy and Pregnancy of Unknown Location: 10 Years’ Experience in a Tertiary Center

The Use of Single Dose Methotrexate in the Management of Ectopic Pregnancy and Pregnancy of Unknown Location: 10 Years’ Experience in a Tertiary Center

Foley Catheter Tourniquet for Uncontrollable Extra-Uterine Placental Hemorrhage: Description of a Novel Surgical Technique

Multidose methotrexate treatment of cornual pregnancy after in vitro fertilization: Two case reports

Contact Info

Product

Resources

About