Transabdominal ultrasound‐guided injection of methotrexate in the treatment of ectopic interstitial pregnancies

Framarino-dei-Malatesta, Marialuisa; Piccioni, Maria Grazia; Derme, Martina; Polidori, Nicoletta Fabiana; Tibaldi, Valentina; Iannini, Isabella; Masselli, Gabriele

doi:10.1002/jcu.22185

Cited by 13 publications

(5 citation statements)

References 22 publications

(23 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Nevertheless, low-dose MTX treatment has been shown to have no effect on coexisting IUP [ 29 ]. The ultrasound-guided local injection of 25 mg MTX has been reported to terminate IPs without affecting IUPs [ 54 , 55 ]. Studies have also proved that MTX doses within the range of 12.5–30 mg will not affect the growth and intelligence of infants [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…Wu et al [ 56 ] reported seven cases of suspected HP with an EP mass less than 4 cm in length, and they achieved good outcomes after expectant treatment. Certainly, there are other reports of IUP miscarriage (1/3) [ 55 ]. However, based on the current limited clinical research [ 57 , 58 , 59 ], the survival rate of IUP with this treatment remains unclear.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Successful Ultrasound-Guided Methotrexate Intervention in the Treatment of Heterotopic Interstitial Pregnancy: A Case Report and Literature Review

Tan

Chen

et al. 2023

JPM

View full text Add to dashboard Cite

Purpose: This study aims to share the experience of minimally invasive ultrasound-guided methotrexate intervention in the treatment of heterotopic interstitial pregnancy (HIP) with good pregnancy outcomes, and to review the treatment, pregnancy outcomes, and impact on the future fertility of HIP patients. Methods: The paper describes the medical history, clinical manifestations, treatment history, and clinical prognosis of a 31-year-old woman with HIP, and reviews cases of HIP from 1992 to 2021 published in the PubMed database. Results: The patient was diagnosed with HIP by transvaginal ultrasound (TVUS) at 8 weeks after assisted reproductive technology. The interstitial gestational sac was inactivated by ultrasound-guided methotrexate injection. The intrauterine pregnancy was successfully delivered at 38 weeks of gestation. Twenty-five HIP cases in 24 studies published on PubMed from 1992 to 2021 were reviewed. Combined with our case, there were 26 cases in total. According to these studies, 84.6% (22/26) of these cases were conceived by in vitro fertilization embryo transfer, 57.7% (15/26) had tubal disorders, and 23.1% (6/26) had a history of ectopic pregnancy; 53.8% (14/26) of the patients presented with abdominal pain and 19.2% (5/26) had vaginal bleeding. All cases were confirmed by TVUS. In total, 76.9% (20/26) of intrauterine pregnancies had a good prognosis (surgery vs. ultrasound interventional therapy 1:1). All fetuses were born without abnormalities. Conclusions: The diagnosis and treatment of HIP remain challenging. Diagnosis mainly relies on TVUS. Interventional ultrasound therapy and surgery are equally safe and effective. Early treatment of concomitant heterotopic pregnancy is associated with high survival of the intrauterine pregnancy.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Successful Ultrasound-Guided Methotrexate Intervention in the Treatment of Heterotopic Interstitial Pregnancy: A Case Report and Literature Review

Tan

Chen

et al. 2023

JPM

View full text Add to dashboard Cite

show abstract

“…So far, MTX is frequently applied as a gold non‐surgical medication for ectopic pregnancy . It was reported that 25 mg MTX local injection into the ectopic sac or embryo was effective for ectopic interstitial pregnancies . However, during heterotopic interstitial pregnancy, the MTX injection becomes controversial because of its fetal toxicity.…”

Section: Discussionmentioning

confidence: 99%

“…19 It was reported that 25 mg MTX local injection into the ectopic sac or embryo was effective for ectopic interstitial pregnancies. 20 However, during heterotopic interstitial pregnancy, the MTX injection becomes controversial because of its fetal toxicity. The US Food and Drug Administration labeled MTX contraindicated during pregnancy and lactation.…”

Section: Discussionmentioning

confidence: 99%

The effect of local aspiration and methotrexate injection on live interstitial pregnancy coexisting with live intrauterine pregnancy after assisted reproductive technology

Yang

Zhu

Fang

et al. 2019

J of Obstet and Gynaecol

View full text Add to dashboard Cite

Aim To share the experience of local aspiration and instillation of methotrexate (MTX) to selective reduction of live interstitial pregnancy and to evaluate its clinical effect and the outcome of intrauterine pregnancy. Methods Twelve patients with heterotopic interstitial pregnancy were enrolled at Women's Hospital, Zhejiang University School of Medicine, from 2006 to 2017. All the pregnancies were derived from assisted reproductive technology (ART). The transvaginal aspiration to interstitial pregnancy sac and local instillation of MTX (range from 12.5 to 30 mg) were performed for the patients under ultrasound‐guide. The prognosis and pregnancy outcomes were followed up. Results No severe side effects of medical treatment were observed in all patients. Three cases underwent subsequent laparotomy cornual resection, and no perioperative complications were found in these three patients. Twelve patients gave birth to 13 healthy infants without congenital anomalies. The average birth weight and gestational age was 2837 g (SD ± 605 g) and 36.8 weeks (SD ± 2.4 weeks). No growth anomalies and mental retardation were observed in live birth offspring. Conclusion The transvaginal ultrasound‐guided aspiration and injection of MTX might be a feasible alternative treatment for heterotopic interstitial pregnancy when vital signs of patients are stable.

show abstract

“…The decision to inject methotrexate directly into the gestational sac was for the purpose of increasing the success of local treatment. A retrospective survey of direct methotrexate injection into the gestational sac under ultrasound visualization in 14 hemodynamically stable patients with interstitial pregnancy showed that this technique is an effective alternative to surgery [25]. Here 1 mL of fluid was aspirated from the gestational sac and 1 mL of methotrexate solution was injected, to avoid sac overdistension and decrease the risk of interstitial rupture.…”

Section: Discussionmentioning

confidence: 99%

Hysteroscopic Methotrexate Injection Under Ultrasonographic Guidance for Interstitial Pregnancy

Leggieri

Guasina

Casadio

et al. 2016

Journal of Minimally Invasive Gynecology

View full text Add to dashboard Cite

Transabdominal ultrasound‐guided injection of methotrexate in the treatment of ectopic interstitial pregnancies

Cited by 13 publications

References 22 publications

Successful Ultrasound-Guided Methotrexate Intervention in the Treatment of Heterotopic Interstitial Pregnancy: A Case Report and Literature Review

Successful Ultrasound-Guided Methotrexate Intervention in the Treatment of Heterotopic Interstitial Pregnancy: A Case Report and Literature Review

The effect of local aspiration and methotrexate injection on live interstitial pregnancy coexisting with live intrauterine pregnancy after assisted reproductive technology

Hysteroscopic Methotrexate Injection Under Ultrasonographic Guidance for Interstitial Pregnancy

Contact Info

Product

Resources

About