Early prediction for the requirement of second or third dose methotrexate in women with ectopic pregnancy, treated with single-dose regimen

Yıldırım, Ayşegül; Cırık, Derya Akdağ; Altay, Metin; Gelişen, Orhan

doi:10.1007/s00404-014-3593-x

Cited by 17 publications

(22 citation statements)

References 20 publications

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“…The mean age was 28.4 ± 4.9 years (minimum 18 and maximum 45 years). The age group [25][26][27][28][29][30] was the most frequent and [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] represented 87.7% of the sample. Amenorrhea was present, but pain and menorrhagia were absent on 18 and 36.3% respectively.…”

Section: Resultsmentioning

confidence: 99%

“…the majority of patients were represented by the [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] age range (Table 2) ，like found in other publications [17], probably due to the fact that it is the age of maximum pregnancy rate even in intra uterine pregnancies studies [18]. Up to 29.4% didn't chose an appropriate health facility, and were referred from another health facility, adding another delay in the management (Table 3).…”

Section: Socio-demographic and Clinical Datamentioning

confidence: 99%

“…The success of single-dose MTX therapy can be affected by the patientʼs serum β-hCG levels, positive fetal cardiac activity, the presence of a yolk sac, and the size of the ectopic mass [29]. The relation between the occurrence of rupture and β-hCG value is unknown.…”

Section: Success Rate After Mtx Protocolmentioning

confidence: 99%

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Widening the Field of Indication of Conservative Management of Unruptured Tubal Pregnancy in Low Resources Settings: Lessons Learnt from 10-year Experience in Three University Teaching Hospitals in Yaoundé (Cameroon)

Valère¹

2019

JGO

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Ectopic pregnancy is the leading cause of maternal mortality in the first trimester. When a patient is admitted before rupture, organ-preserving management which keeps a higher fertility rate than ablative surgery can be done. The incidence of Unruptured Ectopic Pregnancy (UTP) on admission is unknown. In the study facilities, methotrexate treatment was given to most of UTP regardless of Fernandez score. The aim of this study was therefore to assess the lessons learnt from that experience. Methods: It was a cross sectional study over a 10 years period, conducted in four university teaching hospitals affiliated to the University of Yaoundé I, Cameroon. Included patients were managed either by therapeutic abstention, single or multidose intra muscular MTX. Onset of clinical acute abdomen was the only indication of failure of conservative management and prompted emergency laparotomy. Results: We included 153 UTP cases. The incidence of UTP on admission was 0.46%, the mean age 28.4 ± 4.9, 88.2% were admitted at a gestational age <9 weeks, 19% had no pelvic pain. Medical treatment by MTX success rate was 81.7% but was not related to mono or multiple-dose (p=0.87), the success rate when β-hCG value was ≥ 10000 mIU/ml was 63.3% (p=0.004). When Fernandez score was ≥ 13, 21/25 (84%) were still successful including 3/7 with cardiac activity. (p=0.007). Conclusions: The incidence of UTP on admission is approximately 1/10 th of all EP. Some UTP patients should be given MTX treatment opportunity even when Fernandez score recommends surgical management.

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Section: Resultsmentioning

confidence: 99%

Section: Socio-demographic and Clinical Datamentioning

confidence: 99%

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Widening the Field of Indication of Conservative Management of Unruptured Tubal Pregnancy in Low Resources Settings: Lessons Learnt from 10-year Experience in Three University Teaching Hospitals in Yaoundé (Cameroon)

Valère¹

2019

JGO

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“…Less than 22% reduction in human chorionic gonadotropin levels from day 1 to 4 was found to be a predictive factor for the requirement of an additional dose of methotrexate in single-dose regime. (14) Gabbur et al reported that absolute levels of beta-HCG on day 4 after methotrexate treatment were not shown to be a good predictor for treatment success. Only day 7 HCG values were associated with successful single-dose therapy.…”

Section: Variablementioning

confidence: 99%

Can Initial Βhcg Values Predict the Need for Second Dose of Methotrexate in Medical Management of Ectopic Pregnancy?

Narayanan¹

2016

jebmh

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INTRODUCTION Prediction of requirement of second dose of methotrexate in patients treated with single dose would help in guiding treatment and counseling. The aim of this study is to determine whether pretreatment beta HCG values can predict the need for second dose of methotrexate in medically managed ectopic pregnancy. MATERIALS AND METHODS 46 women with ectopic pregnancies who were managed medically were included. The median of beta HCG titres on day 1, day 4 and day 7 was assessed in patients who responded to single dose methotrexate and those who required a second dose. RESULTS Out of the 46 patients studied, 41 responded to medical treatment (success 91%). 14 out of 41 required second dose of methotrexate (34%). Two patients required third dose of methotrexate. Five patients required surgery. DISCUSSION The median of day 1 and day 4 beta HCG values were not statistically different between those who responded to single dose methotrexate and those who required a second dose. Only day 7 values were found to be different. CONCLUSION The beta-hCG titre on day 1 and day 4 is not a predictor of requirement of second dose of methotrexate.

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“…Ectopic pregnancy is a major concern in women's health with a reported incidence of approximately 2% . This incidence is rising due to the increased use of assisted reproductive technologies and increase in pelvic inflammatory diseases . Ectopic pregnancy can lead to morbidity and even mortality from intra‐abdominal bleeding due to tubal rupture .…”

Section: Introductionmentioning

confidence: 99%

Predicting success of methotrexate treatment by pretreatment HCG level and 24‐hour HCG increment

Saleh

Haj-Yahya

Matan

et al. 2017

Intl J Gynecology & Obste

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Early prediction for the requirement of second or third dose methotrexate in women with ectopic pregnancy, treated with single-dose regimen

Cited by 17 publications

References 20 publications

Widening the Field of Indication of Conservative Management of Unruptured Tubal Pregnancy in Low Resources Settings: Lessons Learnt from 10-year Experience in Three University Teaching Hospitals in Yaoundé (Cameroon)

Widening the Field of Indication of Conservative Management of Unruptured Tubal Pregnancy in Low Resources Settings: Lessons Learnt from 10-year Experience in Three University Teaching Hospitals in Yaoundé (Cameroon)

Can Initial Βhcg Values Predict the Need for Second Dose of Methotrexate in Medical Management of Ectopic Pregnancy?

Predicting success of methotrexate treatment by pretreatment HCG level and 24‐hour HCG increment

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