Treatment of an interstitial pregnancy with actinomycin D. Case report

Altaras, Marco M.; Cohen, Ilan; Cordoba, Mario; Ben-Nun, Isaac; Ben-Aderet, N

doi:10.1111/j.1471-0528.1988.tb06826.x

Cited by 30 publications

(18 citation statements)

References 6 publications

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“…(1987) have shown that actinomycin‐D is as effective as methotrexate in gestational trophoblastic disease, with less morbidity than methotrexate. There is a single report of actinomycin‐D in ectopic pregnancy (Altaras et al 1988). Previously, the highest level of HCG in any ectopic pregnancy treated successfully with chemotherapy was 60 000 mlU/ml in a cervical pregnancy treated with methotrexate (Kaplan et al 1989).…”

Section: Discussionmentioning

confidence: 99%

Advanced cervical pregnancy treated with actinomycin‐D

Brand¹,

Rs²,

Davidson³

1993

BJOG

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Section: Discussionmentioning

confidence: 99%

Advanced cervical pregnancy treated with actinomycin‐D

Brand¹,

Rs²,

Davidson³

1993

BJOG

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“…Tanaka et al [12] and recently Altaras et al [13], reported on the successful use of methotrexate and Actinomycin D, respectively, in the treatment of interstitial ectopic pregnancy. They warn, however, of undesirable side effects and possible increased incidence of congenital fetal anomalies following cytotoxic therapy.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Bilateral Tubal Ectopic Pregnancy by Conservative Tubal Surgery

et al. 1993

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JA Unuighe, FS Shaheen, MH Hassonah, AH Abdulla, Treatment of Bilateral Tubal Ectopic Pregnancy by Conservative Tubal Surgery. 1993; 13(2): 190-193 Several reports on multiple ectopic pregnancy have inundated medical journals during the last two decades, including two recent case reports from the Middle East [1,2], each addressing combined extrauterine and intrauterine pregnancy. Many of these are associated with induction of ovulation. This case report, in addition to adding to the number of reported cases, is presented because of the peculiarity of clinical presentation and the successful conservative surgical treatment of bilateral tubal pregnancy encountered at laparotomy. Case ReportA 23-year-old Saudi female, para 1 + 0, had a cesarean section delivery two years prior to presentation. She was admitted with acute abdominal pain associated with vomiting and dysuria the night of 23 January 1992. She had seven weeks of amenorrhea with a positive report on pregnancy test conducted on an early morning specimen of urine one week prior to admission. There was no history of infertility investigation or induction of ovulation. On clinical assessment, her vital signs were stable. Examination revealed a scaphoid abdomen with marked tenderness confined to the suprapubic, iliac, and lumbar regions. No masses were palpable and there was no evidence of fluid collection. On pelvic examination, there was brown vaginal discharge. The cervix was long with a closed os and there was minimal cervical excitation pain. The uterus was slightly bulky and no adnexal masses were palpable. A diagnosis of severe urinary tract infection in early pregnancy was made. The possibility of an ectopic pregnancy was, however, entertained. Immediate microscopy on a midstream specimen of urine yielded 10-15 WBCs per high power field with a bacterial colony count greater than 10 5 /ml, and subsequent culture grew E. coli. She made remarkable clinical progress overnight while on intravenous fluid and antibiotic therapy. Ultrasonic abdominal and transvaginal pelvic scan conducted in the morning revealed a slightly bulky uterus with thickened endometrium containing some blood streaks but no fetal echos in the cavity. There was evidence of an echogenic mass 5.5 x 3.5 cm situated in the pouch of Douglas, more to the right side, with some fluid collection. Both ovaries were visualized and separate from the mass. The findings were suggestive of a right tubal ectopic gestation.On the strength of the ultrasound findings, arrangements were made for emergency exploratory laparotomy. Laparotomy was performed by excision of a wide, poorly healed, subumbilical midline keloid scar tissue.The findings at laparotomy were as follows: the uterus was within normal limits in size with no evidence of pregnancy. There was a dark brown swelling of the ampulla of the left fallopian tube, measuring about 2 cm in diameter and 3 cm in length close to the fimbria with some trickling of blood through the fimbrial ostium into the peritoneal cavity. The right ampulla contained...

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“…Methotrexate has recently been used for cases of unruptured tubal ectopic pregnancies [4][5][6][7] . Despite the use of methotrexate in cases of ectopic pregnancy, its effect on the protection of tubal function is still discussed [3,[8][9][10][11][12] .…”

Section: Discussionmentioning

confidence: 99%

“…To reduce the side effects associated with systemic methotrexate treatment, local methotrexate treatment has been proposed. Local methotrexate injection with ultrasound guidance for the treatment of ectopic pregnancy was first used by Feichtinger and Kemeter [3] in 1987 and many other studies have been published since [4][5][6][7] . However, the effects of methotrexate injection on the tubes for the treatment of tubal pregnancy are still under investigation [3,[8][9][10][11][12] .…”

Section: Introductionmentioning

confidence: 99%

Effects of Methotrexate on the Tubal Morphology of Rabbits: Evaluation by Electron Microscopy

Çetin

Arısoy²,

Tap³

et al. 2008

Gynecol Obstet Invest

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Background/Aims: To evaluate by electron microscopy the effects of methotrexate on the tubal morphology of rabbits. Methods: Biopsies were taken from the isthmic portion of both tubes of 4 rabbits in the control group. 1 mg/kg methotrexate was injected in the left tubes and as a control, a 14-gauge fine needle was used to puncture the right tubes of 10 rabbits in the study group. One month later, tubal biopsies were taken from both tubes of every rabbit in the study group. To mimic pregnancy, 100 IU hCG was injected intramuscularly to every rabbit 24 h before every surgery. On examination by electron microscopy, the effects of methotrexate and of the damage with the fine needle on the tubes were compared to the control group. Results: Young epithelial cells of the methotrexate-injected fallopian tubes kept their normal structure, but others contained important ultrastructural changes. These were: nuclear pyknosis, cytoplasmic vacuolization, dilatation of endoplasmic reticulum cisternae, increased cytoplasmic density and compound cilia. Conclusion: Degenerative changes on epithelial cells caused by the temporary blockage of mitotic activity associated with local methotrexate injection are reversible through the formation of new epithelial cells.

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Treatment of an interstitial pregnancy with actinomycin D. Case report

Cited by 30 publications

References 6 publications

Advanced cervical pregnancy treated with actinomycin‐D

Advanced cervical pregnancy treated with actinomycin‐D

Treatment of Bilateral Tubal Ectopic Pregnancy by Conservative Tubal Surgery

Effects of Methotrexate on the Tubal Morphology of Rabbits: Evaluation by Electron Microscopy

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