Efficacy of frozen-section evaluation of uterine curettings in the diagnosis of ectopic pregnancy

Spandorfer, SD; Aw, Menzin; Kt, Barnhart; Va, LiVolsi; Sm, Pfeifer

doi:10.1053/ob.1996.v175.a73599

Cited by 38 publications

(9 citation statements)

References 9 publications

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“…Even with the meticulous method of diagnosis that was described earlier, 3 women were identified falsely as having an EP, on the basis of the reading of a frozen section. Reliance on frozen sections to identify chorionic villi is known to be reliable, but imperfect, because of the potential of a false-positive diagnosis of women with EP (31). Had uterine contents not been evaluated, a greater number of women with abnormal intrauterine pregnancies would have been diagnosed and treated as an EP.…”

Section: Discussionmentioning

confidence: 99%

Use of “2-dose” regimen of methotrexate to treat ectopic pregnancy

Barnhart

Hummel

Sammel

et al. 2007

Fertility and Sterility

104

106

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Section: Discussionmentioning

confidence: 99%

Use of “2-dose” regimen of methotrexate to treat ectopic pregnancy

Barnhart

Hummel

Sammel

et al. 2007

Fertility and Sterility

104

106

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“…The incidence of a persistent EP after conservative surgery ranges from 5 -10%. MTX can also be used prophylactically to prevent persistent EP at the time of conservative surgical intervention [20,21]. There have been many uncontrolled studies reporting that systemic im.…”

Section: Current Best Practicementioning

confidence: 99%

The pharmacology of methotrexate

Barnhart¹,

Coutifaris²,

Esposito³

2001

Expert Opinion on Pharmacotherapy

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Ectopic pregnancy (EP) is a major cause of maternal morbidity and mortality. The treatment of this condition is primarily surgical, but medical management in selected cases is safe, effective, cost-effective and eliminates the morbidity of surgery. Methotrexate (MTX) is a folate antagonist that can be used for non-oncologic purposes including the treatment of EP. The dose and duration of MTX therapy for EP is much lower than that used in oncology cases, thus reducing side effects and increasing safety. MTX selectively acts on rapidly dividing cells, such as trophoblast cells which comprise the implantation site of the early gestation. The two most common methods of administering MTX to patients with EP are im. administration of a single-dose, based on body surface area and calculated by the equation 50 mg/m(2) (without the need for leucovorin rescue), or the multiple-dose regimen of 1 mg/kg of MTX, alternating with 0.1 mg/kg of leucovorin rescue. Both methods have a similar side effect profile, resulting in the rare occurrence of nausea, vomiting, stomatitis, elevated liver function tests, anorexia and diarrhoea. The two methods yield success rates similar to those of conservative surgical therapy with similar future fertility. The potential single- and multi-dose methods have never been directly compared, but it appears that the success of multiple dosing is more effective. As the efficacy of MTX therapy is not 100%, women must be followed clinically until there is compete resolution of human Chorionic Gonadotropin (hCG) titres from their serum.

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“…Patients who are not compliant or have no one else at home who can assist them should be admitted until the diagnosis becomes clear. If the pregnancy is deemed nonviable by evidence of falling hCG levels or progesterone <5 ng/ml, or is otherwise unwanted, dilatation and curettage (D&C) with frozen section evaluation of uterine curettings may be useful 37. If villi are present, the diagnosis of ectopic pregnancy may be ruled out.…”

Section: Diagnosismentioning

confidence: 99%

Ectopic Pregnancy

Luciano

Roy

Solima

2001

Annals of the New York Academy of Sciences

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During the past 25 years, the incidence of ectopic pregnancy has progressively increased while the morbidity and mortality have substantially decreased, and the treatment has progressed from salpingectomy by laparotomy to conservative surgery by laparoscopy and more recently to medical therapy. This therapeutic transition from surgical emergency to medical management has been attributed to early diagnosis through the use of sensitive assays for hCG and the high definition of vaginal ultrasound. By using these sensitive diagnostic tools, we are now able to select those patients who are most likely to respond to medical management versus those who are at high risk of rupture and require surgery. Besides being less invasive and associated with significantly lower risks, medical therapy with methotrexate results in significant cost savings, which have been calculated to be approximately $3,000 per treated patient. Our goal is to identify those patients with ectopic pregnancy who are most likely to respond to methotrexate therapy and least likely to develop significant side effects. Recent studies have helped us define the predictors of success with methotrexate treatment in women with ectopic pregnancy. The reported success rates of treating ectopic pregnancy with methotrexate vary from 71% to 100%. The highest success rates have been reported from institutions that have detailed diagnostic and therapeutic protocols, readily available assays for serum hCG levels, high-resolution vaginal probe ultrasound, and support staff that can closely monitor clinical response. The importance of developing specific protocols to create a clinical environment that supports the effective use of medical therapy for ectopic pregnancy is confirmed by the associated cost savings, decreased morbidity, and patient preference. Modern diagnostic advances and minimally invasive treatments coupled with improved success rates for assisted reproductive technologies should reduce the morbidity and mortality associated with ectopic pregnancy and offer the affected couple a much more optimistic outlook for subsequent reproductive potential.

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Efficacy of frozen-section evaluation of uterine curettings in the diagnosis of ectopic pregnancy

Cited by 38 publications

References 9 publications

Use of “2-dose” regimen of methotrexate to treat ectopic pregnancy

Use of “2-dose” regimen of methotrexate to treat ectopic pregnancy

The pharmacology of methotrexate

Ectopic Pregnancy

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