Conservative management of ectopic pregnancy: prospective randomized clinical trial of methotrexate versus prostaglandin sulprostone by combined transvaginal and systemic administration

Thirty patients with unruptured ectopic pregnancy (4–10 weeks’ gestation) were treated locally with methotrexate (MTX) under sonographic guidance. The transvaginal puncture was performed under analgesic sedation using an automatic puncturing device. Local MTX therapy was successful in 25 patients (83.3%). Eighteen of these patients had received a single MTX instillation with a total dose of 10 mg, 7 patients had received a second instillation with 10 mg because of plateauing hCG levels after the first instillation. In 5 patients MTX therapy was unsuccessful. Surgical intervention was necessary within 4 h to 15 days after MTX treatment, due to severe tubal bleeding (n = 1) or the development of an increasing peritubal hematoma (n = 4). Patients with an outer trophoblast diameter < 1.5 cm could be treated successfully in all cases (25/25). In patients with hCG values > 5,000 mlU/ml the success rate was 70% (7/10) and in patients with demonstration of cardiac activity of the embryo 63% (5/8). The fluid aspirated from the ectopic cavity showed an average hCG concentration that was 53 times higher than in the serum. The decline in hCG to values below 10mlU/ml ranged between 7 and 75 days (mean 28 days). The hysterosalpingography performed 4–6 months after MTX therapy showed tubal patency on both sides in 85.7% of the patients examined. In the meantime 4 of these patients gave birth to healthy children.

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“…Similarly good results (64%), although with a clearly higher dosage (1 mg/kg), were recently reported by Fernandez et al [10].…”

Section: Discussionsupporting

confidence: 83%

“…Some authors [10,15] attribute the effectiveness of MTX therapy to the serum hCG level. Serum hCG levels above 5,000 mlU/ml are considered unfavorable.…”

Section: Discussionmentioning

confidence: 99%

Unruptured Tubal Pregnancy: Local Low-Dose Therapy with Methotrexate under Transvaginal Ultrasonographic Guidance

Merz

Bahlmann

Weber

et al. 1996

Gynecol Obstet Invest

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“…É reconhecido na literatura 15,16 que quanto maior o nível inicial do β-hCG, pior é a resposta ao tratamento com o MTX, portanto, o sucesso da terapêutica está associado a baixas concentrações do β-hCG, que levam a reduzido estímulo hormonal gestacional e menor atividade trofoblástica. Desta forma, acreditamos que tal constatação confirma nossa linha de pensamento.…”

Section: Discussionunclassified

Espessura Endometrial como Fator Orientador do Tratamento Clínico da Gravidez Tubária Íntegra

Soares¹,

Elito²,

Han³

et al. 2002

Rev. Bras. Ginecol. Obstet.

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IntroduçãoApesar da grande evolução dos métodos diagnósticos por meio da ultra-sonografia (US) transvaginal e dosagem da fração beta do hormônio gonadotrópico coriônico (β-hCG), a gravidez ectópica (GE) continua sendo uma das mais graves afecções da mulher durante sua vida reprodutiva. Nos últi-mos anos, atingiu a proporção de 1 em cada 100 gravidezes normais nos Estados Unidos da Améri-ca 1 , com taxa de mortalidade de 3,8 para 10.000 casos no ano de 1989 2,3 . O desenvolvimento da US transvaginal e o aperfeiçoamento das titulações do β-hCG permitem hoje em dia o diagnóstico mais precoce da GE, propiciando condutas conservadoras que preservam a tuba comprometida [4][5][6] . Com essa evolução, a ênfase da terapia da GE passou de cirurgia de emergência com retirada da tuba para controlar a hemorragia, a tratamento que permite preservar a tuba e a função reprodutiva das pacientes antes que ocorra a rotura tubária.A cirurgia conservadora laparoscópica ou laparotômica, tratamento medicamentoso (metotrexato (MTX), glicose hipertônica, KCl,

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“…After informed consent had been obtained, the sonographically guided puncture was performed using the technique that has been described previously [7,8]. The location of the needle guided by a transvaginal ultrasonography probe was ascertained on the screen, and 1 ml of 25 mg/ml methotrexate solution was injected.…”

Section: Methodsmentioning

confidence: 99%

Conservative Management of Ectopic Pregnancy with Fetal Cardiac Activity by Combined Local (Sonographically Guided) and Systemic Injection of Methotrexate

Halperin

Vaknin²,

Yaron³

et al. 2003

Gynecol Obstet Invest

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Objective: To evaluate the efficacy of conservative management of ectopic pregnancy with fetal cardiac activity by combined local sonographically guided and systemic injection of methotrexate. Study Design: The study group included 12 patients with ectopic pregnancy and fetal cardiac activity, treated by combined local and systemic injection of methotrexate in the period from January 1, 2000 to July 1, 2002. The outcome of these patients was compared with the outcome of 53 patients who had ectopic pregnancy without fetal cardiac activity and were being treated only by systemic injection of methotrexate during the same period of time. Results: The success rate was 91.6% (11 out of 12) in the group of patients with ectopic fetal cardiac activity and 90.5% (48 out of 53) in the group of patients with ectopic pregnancy, but without fetal cardiac activity. There was also no significant difference between the two groups comparing the percentage of cases treated by an additional dose of methotrexate (8.3 and 13.2%, respectively), nor comparing the number of days to resolution of β-human chorionic gonadotrophin (BHCG; 40 ± 2 and 34 ± 10 days, respectively). Conversely, there was a significant difference in the initial BHCG level comparing the group of patients treated by combined local and systemic injection of methotrexate (12,616 ± 9,585 mIU/ml) and the group of patients treated by systemic injection of methotrexate (1,499 ± 2,065 mIU/ml) (p < 0.00001). Seventy-five percent of patients (6 out of 8) diagnosed with ectopic fetal cardiac activity, who desired to become pregnant, succeeded to conceive within 6 months following the combined local and systemic injection of methotrexate. Conclusion: The combined local sonographically guided and systemic injection of methotrexate is associated with a successful outcome in asymptomatic patients presenting with ectopic pregnancy and fetal cardiac activity.

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Conservative management of ectopic pregnancy: prospective randomized clinical trial of methotrexate versus prostaglandin sulprostone by combined transvaginal and systemic administration

Cited by 33 publications

References 18 publications

Unruptured Tubal Pregnancy: Local Low-Dose Therapy with Methotrexate under Transvaginal Ultrasonographic Guidance

Unruptured Tubal Pregnancy: Local Low-Dose Therapy with Methotrexate under Transvaginal Ultrasonographic Guidance

Espessura Endometrial como Fator Orientador do Tratamento Clínico da Gravidez Tubária Íntegra

Conservative Management of Ectopic Pregnancy with Fetal Cardiac Activity by Combined Local (Sonographically Guided) and Systemic Injection of Methotrexate

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