TITLE

Methotrexate for ectopic pregnancy: when and how

AUTHOR(S)
Cecchino, Gustavo; Araujo Júnior, Edward; Elito Júnior, Julio
PUB. DATE
September 2014
SOURCE
Archives of Gynecology & Obstetrics;Sep2014, Vol. 290 Issue 3, p417
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Purpose: Ectopic pregnancy is the leading cause of maternal death in the first trimester of pregnancy. The dosage of beta fraction of human chorionic gonadotropin (beta-hCG) and improvement of the transvaginal ultrasound allowed an earlier diagnosis and a conservative management. Currently, the use of systemic methotrexate (MTX) proved to be a great alternative with similar success rates and completely non-invasive. Methods: We searched for the most relevant articles on the use of MTX in ectopic pregnancy published between 2003 and 2013 in high-impact journals. We performed a strategic search at the Centre for Reviews and Dissemination (CRD), Database of Abstracts of Reviews of Effects (DARE), National Institute for Health Research (NHS), International Prospective Register of Systematic Reviews (PROSPERO), The Cochrane Database of Systematic Reviews (CDSR) and Medical Literature Analysis and Retrieval System Online (MEDLINE) according to the descriptors 'pregnancy, ectopic' and 'methotrexate', alone or combined. Results: Thus, we based this review on 32 studies that were classified following the grades of recommendation and levels of evidence proposed by the Oxford Centre for Evidence-Based Medicine. Additionally, selected papers were used. Scientific evidence points to a growing trend in the choice of conservative treatment for ectopic pregnancies, whereas expectant management still lacks studies for definitive conclusions. Indeed, the well-established protocols which exhibit a greater number of studies are still based on the single-dose treatment. Conclusion: Considering MTX, it proved to be more effective in cases of low titers of beta-hCG and masses with a small diameter, although there is still no uniformity of these parameters. The choice largely depends on the experience of the medical team and ultimately, on the woman's reproductive desire.
ACCESSION #
97412158

 

Related Articles

  • Diagnosis and Management of Ectopic Pregnancy: Green-top Guideline No. 21.  // BJOG: An International Journal of Obstetrics & Gynaecology;Dec2016, Vol. 123 Issue 13, pe15 

    The article reports on guideline for management and diagnosis of ectopic pregnancy (EP). Topics discussed include diagnosis of EP using transvaginal ultrasound and serum levels of beta-human chorionic gonadotrophin (b-hCG); management of several types of EP such as tubal EP, cervical EP and...

  • Role of initial and day 4 human chorionic gonadotropin levels in predicting the outcome of single-dose methotrexate treatment in women with tubal ectopic pregnancy. Ustunyurt, Emın; Duran, Muzeyyen; Coskun, Esra; Ustunyurt, Özlem; Şimşek, Harun // Archives of Gynecology & Obstetrics;Nov2013, Vol. 288 Issue 5, p1149 

    Purpose: The purpose of this study was to evaluate the initial and day 4 beta-human chorionic gonadotropin (β-hCG) levels as a predictor of methotrexate (MTX) therapy success for ectopic pregnancy. Methods: Retrospective study of 87 patients with tubal ectopic pregnancy treated with a single...

  • Spontaneous unilateral tubal twin pregnancy. Sur, S. D.; Reddy, K. // Journal of the Royal Society of Medicine;Jun2005, Vol. 98 Issue 6, p276 

    The article discusses the clinical case of a 24-year-old woman who suffered from spontaneous tubal twin pregnancy. Her vaginal examination showed that she is having a left-sided ectopic pregnancy. The Royal College of Obstetricians and Gynaecologists in Great Britain suggested the treatment of...

  • Evaluating the Role of D&C vs Methotrexate in Etopic or Non-viable Intrauterine Pregnancy. Jensen, Jeffrey T. // OB/GYN Clinical Alert;Nov2011, Vol. 28 Issue 7, p49 

    Synopsis: More than 25% of stable women with elevated levels of hCG and no visible intrauterine pregnancy on ultrasound will have a non-viable intrauterine pregnancy, and not an ectopic

  • Tratamiento laparoscópico de una gestación ectópica tubárica gemelar monocorial monoamniótica espontánea. Caso clínico. Pérez-Martín, L.; De León Luis, Juan; Gámez-Alderete, F.; Bravo, C.; F., F. Pérez; A., A. Aguarón; Ortiz, L. // Ginecologia y Obstetricia de Mexico;oct2013, Vol. 81 Issue 10, p612 

    We present a case of a spontaneous live monochorionic monoamniotic twin tubal ectopic pregnancy detected by transvaginal ultrasound scan after medical therapy with single dose of methotrexate failed. The incidence of this type of ectopic pregnancies is probably arising due to the increasing use...

  • Diagnosing suspected ectopic pregnancy. Ankum, Willem M // BMJ: British Medical Journal (International Edition);11/18/2000, Vol. 321 Issue 7271, p1235 

    Editorial. Discusses the various methods of diagnosing ectopic pregnancies. The role of such pregnancies in cases of maternal death; Use of ultrasound in conjunction with serum human chorionic gonadotrophin (HCG) measurements; Development and implementation of transvaginal sonography;...

  • Successful Early Diagnosis Using HCG Ratio of Hemoperitoneum vs. Venous Serum.  // Fertility Weekly;3/15/2010, p9 

    The article reports on a study on the use of human chorionic gonadotropin (hCG) ratio of peritoneal serum and venous serum as early diagnosis of ectopic pregnancies (EP). It notes that EP can be diagnosed in early stages by transvaginal ultrasound and serum hCG. According to the study, no...

  • Predictors of Success of Methotrexate Treatment in Women with Tubal Ectopic Pregnancies. Lipscomb, Gary H.; McCord, Marian L.; Stovall, Thomas G.; Huff, Genelle; Portera, S. Greg; Ling, Frank W. // New England Journal of Medicine;12/23/99, Vol. 341 Issue 26, p1974 

    Background: The use of methotrexate for the treatment of women with tubal ectopic pregnancies is now common practice. However, the clinical and hormonal determinants of the success of this treatment are not known. Methods: We studied 350 women with tubal ectopic pregnancies who were treated with...

  • Conservative Management of Cesarean Scar Ectopic Pregnancy with Fetal Heart Activity and a Very High β-hCG. McLaren, Rodney; McCalla, Sandra; Irani, Mohamad // Case Reports in Obstetrics & Gynecology;12/6/2015, p1 

    Cesarean scar ectopic pregnancy (CSP) is a rare type of ectopic pregnancy that is growing in incidence. The diagnosis of most CSP occurs when patients present in unstable conditions requiring surgical management and leading sometimes to hysterectomy. It has been shown that medical management is...

Share

Read the Article

Courtesy of THE LIBRARY OF VIRGINIA

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics