Histopathology of five tubes after treatment with methotrexate for a tubal pregnancy

Kooi, Sjarlot; Etten, F. H. P. M. Van; Kock, H.C.L.V.

doi:10.1016/s0015-0282(16)54842-0

Cited by 25 publications

(13 citation statements)

References 13 publications

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“…Within the last few years the value of MTX therapy has been advocated not only as a secondary treatment in per sistent trophoblast activity after tube-conserving surgical ectopic pregnancy therapy [16], but predominantly as a primary treatment of an unruptured tubal pregnancy [17,19], cornual pregnancy [28] and cervical pregnancy [29], MTX inhibits trophoblast metabolism [30] without in flicting morphological damage on the tube [31,32], in contrast to the prostaglandins which damage the tropho blast via vasoconstrictive ischemia and at the same time lead to hyperperistalsis of the tube [33].…”

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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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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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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“…8 Regarding the toxicity to the tube of local administration of MTX (50 mg), no effects were reported in a histologic study of intratubal injection of MTX (100 mg). 19 Furthermore, subsequent fertility after local MTX injection was satisfactory. 13,20 Therefore, local administration of MTX (50 mg) was thought to have no toxicity in the tube.…”

Section: Discussionmentioning

confidence: 90%

Persistent Ectopic Pregnancy After Laparoscopic Linear Salpingostomy for Tubal Pregnancy: Prevention and Early Detection

Akira¹,

Abe²,

Takeshita³

2011

Ectopic Pregnancy - Modern Diagnosis and Management

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“…Despite the use of methotrexate in cases of ectopic pregnancy, its effect on the protection of tubal function is still discussed [3,[8][9][10][11][12] . Klinkert et al [13,14] presented a case report of isthmic tubal pregnancies treated with 5 mg local methotrexate injection.…”

Section: Discussionmentioning

confidence: 99%

“…Local methotrexate injection with ultrasound guidance for the treatment of ectopic pregnancy was first used by Feichtinger and Kemeter [3] in 1987 and many other studies have been published since [4][5][6][7] . However, the effects of methotrexate injection on the tubes for the treatment of tubal pregnancy are still under investigation [3,[8][9][10][11][12] . The aim of this study was to investigate the histological differences in the tubes of nonpregnant rabbits 1 month after the injection of local methotrexate.…”

Section: Introductionmentioning

confidence: 99%

Effects of Methotrexate on the Tubal Morphology of Rabbits: Evaluation by Electron Microscopy

Çetin

Arısoy²,

Tap³

et al. 2008

Gynecol Obstet Invest

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Background/Aims: To evaluate by electron microscopy the effects of methotrexate on the tubal morphology of rabbits. Methods: Biopsies were taken from the isthmic portion of both tubes of 4 rabbits in the control group. 1 mg/kg methotrexate was injected in the left tubes and as a control, a 14-gauge fine needle was used to puncture the right tubes of 10 rabbits in the study group. One month later, tubal biopsies were taken from both tubes of every rabbit in the study group. To mimic pregnancy, 100 IU hCG was injected intramuscularly to every rabbit 24 h before every surgery. On examination by electron microscopy, the effects of methotrexate and of the damage with the fine needle on the tubes were compared to the control group. Results: Young epithelial cells of the methotrexate-injected fallopian tubes kept their normal structure, but others contained important ultrastructural changes. These were: nuclear pyknosis, cytoplasmic vacuolization, dilatation of endoplasmic reticulum cisternae, increased cytoplasmic density and compound cilia. Conclusion: Degenerative changes on epithelial cells caused by the temporary blockage of mitotic activity associated with local methotrexate injection are reversible through the formation of new epithelial cells.

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Histopathology of five tubes after treatment with methotrexate for a tubal pregnancy

Cited by 25 publications

References 13 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

Persistent Ectopic Pregnancy After Laparoscopic Linear Salpingostomy for Tubal Pregnancy: Prevention and Early Detection

Effects of Methotrexate on the Tubal Morphology of Rabbits: Evaluation by Electron Microscopy

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