Utilisation du méthotrexate dans les GEU tubaires

Lesavre, M.; Curinier, S.; Capmas, P.; Rabischong, B.; Fernandez, H.

doi:10.1016/j.jgyn.2014.12.013

Cited by 9 publications

(5 citation statements)

References 36 publications

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“…They reported failure of medical treatment and the need for surgical intervention in about 10% of cases. Rates of success of methotrexate in management of ectopic pregnancy varied from 64% to 95% in most previous reports [11,12] This rate is in line with our results and results of previous studies which reported about 80-78.5% success rate [1,4,9]. Additionally, Barbier et al [13] described a global success rate of 79.1%.…”

Section: Discussionsupporting

confidence: 91%

“…Who found that pretreatment levels of is the most important determining factor for treatment response prediction. β-hCG levels above 5000 mIU/mL as a contraindication, of using medical therapy as it is related to a high failure rate and liability for patients deterioration [12,18]. There are many reports which assessed the suitable baseline hCG levels which is predictive of success in methotrexate treatment.…”

Section: Discussionmentioning

confidence: 99%

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Values and predictive factors for Success of Methotrexate Therapy in Medical Management of Ectopic Pregnancy

Lashin

Alabiad

Abdelsalam

2020

Zagazig University Medical Journal

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Background: Using Methotrexate as an option for medical treatment of ectopic pregnancies has been suggested since 1982. Studies regarding the dose, number of doses of methotrexate and the predictive factors of degree of success of methotrexate in the medical management of ectopic pregnancy are limited. Aim of the present article were; to assess the predictive factors of success and efficacy of methotrexate therapy and to assess the value and efficacy of using lower dose of methotrexate and the suitable number of doses for medical management of ectopic pregnancy. Methods: we included 100 patients with ectopic tubal pregnancy that were given Methotrexate dosage 1 mg/kg which was injected intramuscular. After the first injection we asked the patients to return on the 4 th day then on the 7 th day to test the levels of hCG. In case of reduction of the level of β-hCG less than 15% on 4 th and 7 th days, patients were given the second methotrexate dose of 1 mg/kg which was also injected intramuscular. We followed patients until achieving β-hCG target level (<15 mIU/mL) then completely negative values. We assessed rates and predictive factors for success or failure of methotrexate therapy. Results: of the included 100 patients, 15 patients needed surgical management at the end of treatment, with a success rate of medical Methotrexate therapy of 85%.The pretreatment predictive factors of failure of medical treatment are; presence of a pretreatment adnexal mass (p= 0.040), presence of pain (p= 0.039), metrorrhagia (p= 0.023), or hemoperitoneum (p= 0.002). Base line pretreatment hCG levels was the most important predictive factor of therapy success (p= 0.002). Conclusions: methotrexate in a single dose or two doses could effectively treat ectopic pregnancy with fewer side effects providing that base line hCG level < 5000 IU/L in hemodynamically stable young patients with no liver or kidney problems with a higher success rate.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Values and predictive factors for Success of Methotrexate Therapy in Medical Management of Ectopic Pregnancy

Lashin

Alabiad

Abdelsalam

2020

Zagazig University Medical Journal

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“…Certain conditions contraindicate medical treatment, namely lack of understanding of or compliance with follow-up, unstable hemodynamic status (pulse, blood pressure), extra-pelvic effusion on ultrasound, laparoscopy necessary for a definite diagnosis, history of homolateral ectopic pregnancy, tubal ectopic pregnancy with a size of more than 4 cm in diameter, presence of an embryo with cardiac activity. 20,21 Nevertheless, cases of successful medical treatment for an unruptured ectopic pregnancy with a live embryo have been observed, which shows the relativity of the limits in the indications for medical treatment for an unruptured ectopic pregnancy. 22 Regardless of the protocol used, rigorous clinical and biological monitoring is necessary.…”

Section: Interpretation Of the Results In The Light Of The Internatiomentioning

confidence: 99%

Medical management of ectopic pregnancy in a low resource setting: the role of methotrexate

Ndour

Gueye

Diouf

et al. 2021

Int J Reprod Contracept Obstet Gynecol

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Background: Medical treatment using methotrexate. However, its indications and the protocol of administration are still under discussion. Even if follow-up problems are often raised in developing countries, medical treatment of ectopic pregnancy remains a reasonable option that we practice and share our experience here.Methods: We performed a retrospective cohort study of patients managed for an unruptured ectopic pregnancy in two university hospital facilities in Dakar: the Centre Hospitalier National de Pikine and the Centre de Santé de Philipe Maguilen Senghor. The data of this study are spread over a period of 10 years, from 2010 and 2019. We planned to evaluate maternal age, parity, gestational age, diagnosis circumstances, medical management, monitoring, and outcome. A single dose protocol was used. Data extracted from the registries were transferred to Microsoft Excel 2019, Mac version and then moved to SPSS (Statistical Package for Social Sciences, 26.Results: Over ten years, we had registered 18 patients who had received medical treatment out of a total of 263 ectopic pregnancies treated in the two facilities, i.e., a frequency of 6.8%. The average age was 28.8 years. The average initial HCG level was 10,460 mIU/ml. Treatment succeeded in more than 6 out of 10 patients (61.1%). However, we noted 5 cases of failure that had secondarily benefited from salpingectomy by laparotomy.Conclusions: Methotrexate is now part of the therapeutic arsenal in the management of unruptured tubal ectopic pregnancies. However, in developing countries, particularly in Senegal, there is a reluctance to use this therapeutic method, which, however, when a personalized follow-up is carried out, is achievable with a success rate comparable to other therapeutic methods.

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“…In other words, when the base level becomes less than 20 IU / l. The duration of the negativation varies between 25 and 35 days [21,22].…”

Section: Treatment Monitoringmentioning

confidence: 99%

Medical Treatment of Tubar Ectopic Pregnancy with Living Embryo: About Two Cases in Dakar (Senegal)

Gassama¹,

Biaye²,

Niass³

et al. 2019

Gynecol Reprod Health

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Objectives: To evaluate the efficacy of treatment with methotrexate, and the possibility of medical treatment of living embryo. Observation: We report two cases in secondary amenorrhea of 6 weeks received in an algebra table associated with minimal bleeding. The physical examination had found moderate pain in the left iliac fossa for the first patient and for the second patient in the right iliac fossa with minimal bleeding. The first endo-vaginal ultrasound showed a left lateral uterine mass, the second one a right lateral uterine mass containing a living embryo of six-week amenorrhea. We administered a triple dose of methotrexate to both patients whose improvement could be noticed trough a clinical remission and a decrease of the plasmatic βHCG level. Consequently, we decided to release them after 8 days of hospitalization. Conclusion: The medical treatment of tubal ectopic pregnancy with living embryo is difficult due to the work conditions; furthermore, it is a controversial issue in our country.

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Utilisation du méthotrexate dans les GEU tubaires

Cited by 9 publications

References 36 publications

Values and predictive factors for Success of Methotrexate Therapy in Medical Management of Ectopic Pregnancy

Values and predictive factors for Success of Methotrexate Therapy in Medical Management of Ectopic Pregnancy

Medical management of ectopic pregnancy in a low resource setting: the role of methotrexate

Medical Treatment of Tubar Ectopic Pregnancy with Living Embryo: About Two Cases in Dakar (Senegal)

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