Conservative management of nontubal ectopic pregnancies

Verma, Usha; English, D.; Brookfield, Kathleen

doi:10.1016/j.fertnstert.2011.09.021

Cited by 36 publications

(42 citation statements)

References 15 publications

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“…In the published work, no standard protocols for treatment of non‐tubal ectopic pregnancy have been published so far . This could be due to the very poor number of cases but also to the great variability among single cases.…”

Section: Discussionmentioning

confidence: 79%

“…Verma et al . demonstrated that most non‐tubal ectopic pregnancies can be treated with a conservative approach thorough ultrasound‐guided injection of KCl or MTX into the gestational sac, which can be complicated by myometrial hemorrhage with hemoperitoneum, or systemic MTX .…”

Section: Discussionmentioning

confidence: 99%

“…Verma et al 8 demonstrated that most non-tubal ectopic pregnancies can be treated with a conservative approach thorough ultrasound-guided injection of KCl or MTX into the gestational sac, which can be complicated by myometrial hemorrhage with hemoperitoneum, or systemic MTX. 3 This has been considered for many years a safe and effective treatment for ectopic pregnancy, 9 with a higher likelihood of success by lowering quantitative β-hCG, which represents the main prognostic factor.…”

Section: Discussionmentioning

confidence: 99%

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Conservative treatment for interstitial monochorionic twin pregnancy: Case report and review of the published work

Berretta

Merisio

Dall’Asta

et al. 2013

J of Obstet and Gynaecol

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Interstitial pregnancy is considered one of the most hazardous types of ectopic pregnancies, with a mortality rate of 2-2.5%. We describe a case of a viable monochorionic twin pregnancy in a 35-year-old woman successfully treated with systemic methotrexate associated with bilateral uterine arteries' embolization. β-hCG was undetectable 67 days after the first administration of methotrexate and the ultrasonography performed on day 67 showed the remnant of the gestational sac in the right uterine horn, a thin endometrium and a normal myometrial vascularization. Conservative treatment allowed us to avoid surgical treatment and to preserve the patient's fertility.

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Section: Discussionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Conservative treatment for interstitial monochorionic twin pregnancy: Case report and review of the published work

Berretta

Merisio

Dall’Asta

et al. 2013

J of Obstet and Gynaecol

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“…EPs can, however, implant in more unusual locations such as within a Caesarean section scar, within the interstitial portion of the Fallopian tubes, in the cervix, on the ovary and potentially anywhere in the abdominal cavity. Mortality from non-tubal ectopic pregnancies is higher than ectopic pregnancies generally, and they are becoming more common due to assisted reproductive technologies, and possibly due to increasing Caesarean section rates (Chetty and Elson, 2009; Verma et al , 2011). Non-tubal ectopic pregnancies are generally difficult to treat and often require a combination of surgical and medical methods.…”

Section: Introductionmentioning

confidence: 99%

“…The literature around management of non-tubal EPs is limited to case reports and series, describing a range of minimally invasive surgical, radiological and medical interventions including laparoscopic and hysteroscopic resection, uterine artery embolization, ultrasound guided injections of the gestational sac with potassium chloride and/or methotrexate, and systemic treatment with drugs such as methotrexate, mifepristone and misoprostil (Verma et al , 2011; Fylstra, 2012). Treatment choice depends on the site, size and pretreatment serum hCG level of the non-tubal EP.…”

Section: Introductionmentioning

confidence: 99%

Combination gefitinib and methotrexate treatment for non-tubal ectopic pregnancies: a case series

et al. 2014

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Non-tubal ectopic pregnancies are a rare subgroup of ectopic pregnancies implanted at sites other than the Fallopian tube. Mortality from non-tubal ectopic pregnancies is higher compared with that for tubal ectopic pregnancies, and they are becoming more common, partly due to the rising incidence of Caesarean sections and use of assisted reproductive technologies. Non-tubal ectopic pregnancies can be especially difficult to treat. Surgical treatment is complex, and follow-up after medical treatment is usually protracted. There is therefore a need for more effective medical therapies to resolve non-tubal ectopic pregnancies and reduce operative intervention. We have recently reported successful use of combination gefitinib (an orally available epidermal growth factor receptor inhibitor) and methotrexate for treatment of tubal pregnancies. To our knowledge, this combination has not been used to treat non-tubal pregnancies. Here we report the use of combination gefitinib and methotrexate to treat eight women with stable, non-tubal ectopic pregnancies at two tertiary academic teaching hospitals (Edinburgh, UK and Melbourne, Australia); five interstitial and three Caesarean section scar ectopic pregnancies. Pretreatment serum hCG levels ranged from 2458 to 48 550 IU/l, and six women had pretreatment hCG levels >5000 IU/l. The women were co-administered 1–2 doses of i.m. methotrexate (50 mg/m2 on Day 1, ± Day 4 or Day 7) with seven once daily doses of oral gefitinib (250 mg). The women were monitored until complete resolution of the ectopic pregnancy, defined as a serum hCG <15 IU/l. Time to resolution (days from first methotrexate dose until serum hCG <15 IU/l), safety and tolerability, complication rates and subsequent fertility outcomes were also recorded. All eight women were successfully treated with combination gefitinib and methotrexate. The most common side effects were transient acne/rash and diarrhoea, known side effects of gefitinib. All women promptly resumed menstruation and importantly, three women subsequently conceived spontaneously. Two have delivered a healthy infant at term and the third is currently in her second trimester of pregnancy. Hence, our case series supports a future clinical trial to determine the efficacy of combination gefitinib and methotrexate to treat non-tubal ectopic pregnancies.

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A 10‐year retrospective cohort study of non‐tubal ectopic pregnancy management outcomes in an Australian tertiary centre

Loh

Adno

Reid

2022

Australas J Ultrason Med

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Introduction Non‐tubal ectopic pregnancy (NTEP) is a rare but significant early pregnancy complication which can result in maternal morbidity and mortality. There is however a lack of evidence‐based guidelines for the management of NTEP. Purpose To evaluate the success rates of expectant, medical and surgical management in the treatment of NTEP at our tertiary centre. Methods Retrospective cohort study from 2010 to 2020. All NTEP were classified by ectopic sites. Primary management was classified by expectant, medical [systemic methotrexate (Sys‐MTX) and/or local ultrasound‐guided injection of MTX and/or KCl intra‐sac (L‐MTX, L‐MTX/KCl)] or surgical. Primary management was considered successful if no change in intervention was required. Treatment complications were compared. Results Twenty‐four NTEP were identified, which included 14 interstitial pregnancies (IP), 9 caesarean scar pregnancies (CSP) and 1 ovarian pregnancy (OP), which gave NTEP an incidence of 7.12% among all EP (4.15% for IP, 2.67% for CSP and 0.30% for OP). The success of primary surgical management was 100% (7/7), primary medical management was 76.9% (10/13) and primary expectant management was 33.3% (1/3). Primary medical management had a non‐statistically significant greater mean time to serum ß‐human Chorionic Gonadotrophin <5 IU/L, mean length of hospitalisation, mean number of follow‐up visits and hospital re‐presentation/readmissions compared to primary surgical management. There was no other difference in complication rates between the treatment management groups. Conclusion Surgery remains the most effective way to manage NTEP. However, medical management can be a safe and effective alternative option in carefully selected cases.

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Conservative management of nontubal ectopic pregnancies

Cited by 36 publications

References 15 publications

Conservative treatment for interstitial monochorionic twin pregnancy: Case report and review of the published work

Conservative treatment for interstitial monochorionic twin pregnancy: Case report and review of the published work

Combination gefitinib and methotrexate treatment for non-tubal ectopic pregnancies: a case series

A 10‐year retrospective cohort study of non‐tubal ectopic pregnancy management outcomes in an Australian tertiary centre

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