Serum human chorionic gonadotropin clearance curves in patients with interstitial pregnancy treated with systemic methotrexate

Hajenius, Petra J.; Voigt, R; Engelsbel, Simone; Mol, Ben Willem J.; Hemrika, D. J.; Veen, Fulco van der

doi:10.1016/s0015-0282(16)58625-7

Cited by 43 publications

(10 citation statements)

References 13 publications

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“…4) The metabolism of folinic acid in different patients might influence the effect of MTX. This is supported by findings by Hajenius et al (17), who observed that in two groups of patients treated with multiple-dose MTX, different protocols of folinic acid administration determined different patterns of β-hCG curves.…”

Section: Discussionsupporting

confidence: 79%

Predictors of Success of Repeated Injections of Single-dose Methotrexate Regimen for Tubal Ectopic Pregnancy

et al. 2006

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The purpose of this study is to evaluate predictors of success of repeated injections of methotrexate in the single-dose regimen for the treatment of tubal ectopic pregnancy. All patients who had ectopic tubal pregnancy and were treated with a single dose regimen were retrospectively identified. 126 patients were treated with methotrexate. Among them, 39 patients were adequate for this study. 33 were treated with the 2nd dose and 27 were successfully cured. Additionally, 6 who were injected with the 3rd dose were all cured as well. Therefore, in our study, the success rate for the repeated injections of methotrexate was found to be 84.6% (33/39). The mean initial -hCG level was significantly lower in patients who were successfully treated than in patients who failed (3915.3±3281.3 vs. 8379.7±2604.4 IU/mL, p< 0.05). The success rate is 96% when the -hCG level is less than 6,000 IU/mL and is 58% when -hCG is greater than 6,000 IU/mL (OR=18.57, 95% CI 1.86-185.89). The initial -hCG level is the only factor that has significant meaning as predictor of success of repeated injections of methotrexate in the single-dose regimen. Repeated injections of methotrexate may be particularly effective when the initial -hCG level is below 6,000 IU/mL.

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Section: Discussionsupporting

confidence: 79%

Predictors of Success of Repeated Injections of Single-dose Methotrexate Regimen for Tubal Ectopic Pregnancy

et al. 2006

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“…(cases 2 and 5). The serum bhCG clearance curves after systemic methotrexate have been well described in the literature, including the criterion for an additional course, i.e., a serum bhCG concentration on day 14 exceeding 40% of FOV 29,30 . In three cases of this series, we associated a standard MTX treatment with selective prophylactic bilateral uterine artery embolization, in order to prevent profuse vaginal bleeding.…”

Section: Discussionmentioning

confidence: 99%

Cervical pregnancy: A case series and a review of current clinical practice

Cipullo

Cassese

Fasolino

et al. 2008

The European Journal of Contraception & Reproductive Health

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Five consecutive cases of cervical pregnancy (CP) are presented. In four cases, the diagnosis was made at routine check-ups and these were all treated conservatively. In the fifth case, an erroneous diagnosis of inevitable abortion was made, in a patient presenting with profuse vaginal bleeding. Persistent bleeding following curettage required an emergency hysterectomy, after failure of compressive methods. From the four cases treated conservatively, three received standard methotrexate i.m. (MTX) in combination with bilateral uterine artery embolization (UAE). In one case MTX was followed by intraamniotic puncture and instillation of KCl due to persistent embryonic heartbeat. A spontaneous evacuation of the cervical pregnancy occurred in all patients treated conservatively. We postulate that the preventive use of uterine artery embolization in combination with standard MTX treatment could contribute to reduce the risk of excessive bleeding and facilitate spontaneous expulsion. Possible detrimental effects of the treatment on subsequent reproductive capacities and obstetrical outcome are also pointed out. The diagnostic methods and therapeutic approaches are discussed and the literature is reviewed. With referral to the first case of our series, which required an emergency hysterectomy, we want to stress the importance of an early diagnosis for a correct management of this condition.

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“…Therefore, general guidelines are still lacking. As an alternative to surgery, medical management for the treatment of interstitial ectopic pregnancy has been applied [16][17][18][19][20][21]. Mostly methotrexate is used, but in administering methotrexate several problems must be considered; a close medical follow-up has to be performed after its application.…”

Section: Discussionmentioning

confidence: 99%

Suitable laparoscopic surgery in the treatment of ectopic interstitial pregnancy

2005

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Interstitial or cornual pregnancies represent a small fraction of ectopic gestations. They are located in the interstitial part of the fallopian tube. Interstitial pregnancies are especially feared due to their associated life-threatening intra-abdominal haemorrhage. General guidelines for clinical management are lacking. This article describes important specialities in the differentiation between interstitial and classical tubal pregnancies and will further offer a special minimally invasive procedure for the safe management of this rare type of ectopic pregnancy. We favour a special endoscopic operative procedure using a combination of the encircling suture and endoloop techniques. This method provides an excellent tourniquet effect resulting in effective haemostasis. In addition to the different endoscopic treatments, other therapeutic options, such as primary methotrexate application, will be discussed.

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Serum human chorionic gonadotropin clearance curves in patients with interstitial pregnancy treated with systemic methotrexate

Cited by 43 publications

References 13 publications

Predictors of Success of Repeated Injections of Single-dose Methotrexate Regimen for Tubal Ectopic Pregnancy

Predictors of Success of Repeated Injections of Single-dose Methotrexate Regimen for Tubal Ectopic Pregnancy

Cervical pregnancy: A case series and a review of current clinical practice

Suitable laparoscopic surgery in the treatment of ectopic interstitial pregnancy

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