Nonsurgical management of unruptured tubal pregnancy with intra-amniotic methotrexate: preliminary report of two cases

Leeton, John; Davison, G.

doi:10.1016/s0015-0282(16)60026-2

Cited by 30 publications

(11 citation statements)

References 7 publications

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“…A central liquefaction observed in our case at the 27th day appears to occur in about 33% of the formerly solid masses [41]. Other authors also documented the heterogeneous aspect of persistent masses [27,29,30,32,34,36]. These sonographic findings seem to be independent of the administration route of MTX.…”

Section: Discussionsupporting

confidence: 71%

“…The classical treatment of interstitial pregnancy is surgical consisting of laparoscopy and/or laparotomy with resection of the involved uterine horn or even hysterectomy, at times requiring multiple blood transfusions. According to the literature, exclusive medical treatment using methotrexate (MTX) [29][30][31][32][33][34][35][36], potassium chloride [27,28] or even actinomycin D [37] could become an effective alternative. We present a case of a viable interstitial pregnancy which was successfully treated with a combined local and systemic MTX administration.…”

Section: Introductionmentioning

confidence: 99%

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Interstitial Pregnancy Treated with Local and Systemic Methotrexate

Bruyne

Tutschek²,

Hucke³

et al. 1998

Gynecol Obstet Invest

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We present a case of an intact interstitial pregnancy at 6 postmenstrual weeks and 4 days, which was successfully treated by combined local and systemic methotrexate administration. The embryonic cardiac activity stopped within 1 min after uneventful ultrasound-guided puncture and methotrexate instillation of the chorionic sac. While the β-hCG serum values returned to normal 59 days after local, and 52 days after systemic treatment, the echogenic lesion has reduced in size by 50%, but is still sonographically detectable 7 months after the procedure. This report shows that medical treatment of interstitial pregnancy may be an effective alternative to the surgical approach.

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Section: Discussionsupporting

confidence: 71%

Section: Introductionmentioning

confidence: 99%

Interstitial Pregnancy Treated with Local and Systemic Methotrexate

Bruyne

Tutschek²,

Hucke³

et al. 1998

Gynecol Obstet Invest

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“…Only in 4 cases with increasing ß-hCG levels was a repeated local injection of MTX needed. The main potential advantages of local MTX administration versus parenteral administration are its greater antitrophoblastic effect, shorter treatment time, reduced dosage and absence of side effects [12,14,15,21]. It appears that the absence of side effects is due more to the reduced dosage (about one fifth of the parenteral dosage) than to the decreased systemic exposure to significant MTX levels.…”

Section: Discussionmentioning

confidence: 99%

“…Some authors reported an increase in serum ß-hCG levels following MTX administration for 24-72 h before they started to decline [5,14,15,25]. They assumed that this might be explained by necrosis of trophoblastic tissue or by the time needed for the drug to reach therapeutic levels [5].…”

Section: Discussionmentioning

confidence: 99%

Local Application of Methotrexate for Ectopic Pregnancy with a Percutaneous Puncturing Technique

Mesogitis¹,

Antsaklis²,

Papantoniou³

et al. 1998

Gynecol Obstet Invest

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Management of ectopic pregnancy remains traditionally surgical. Early detection of unruptured ectopic pregnancies, using both ultrasound techniques and β-human chorionic gonadotropin (β-hCG) assays, allows a more conservative treatment. Twenty-six tubal pregnancies, which were managed with local methotrexate (MTX) injection, are presented. A single dose of 10–12.5 mg of MTX was percutaneously injected into the gestational sac under abdominal sonographic control. Complete resolution was obtained in all our patients. Four of them required a second percutaneous administration 4 days after the first one. Negligible serum β-hCG levels (<10 mIU/ml) were reached within 42 days after treatment. No systemic side effects were observed. Local administration of MTX under abdominal sonographic control seems to be an effective alternative for the treatment of ectopic pregnancy. The main potential advantages of the method are (1) a greater antitrophoblastic effect; (2) a shorter treatment period; (3) reduced dosage, and (4) absence of side effects.

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“…A1-3 and B1-3 received MTX (1, 2, 5 mg/kg IP) accordingly, plus CF (0.1, 0.2, 0.5 mg/kg IP) for B1-3 24 hours after MTX injection. The range of MTX and CF (AnHui Pharmaceutical Factory, Hefei City, China) was chosen according to the literature (1,2,(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)22). However, we designed a dynamic dose of CF applied in 10% of the MTX dose to evaluate its true capability to protect susceptible endosalpinx tissues.…”

mentioning

confidence: 99%