Local injection of methotrexate dissolved in saline versus methotrexate suspensions for the conservative treatment of ectopic pregnancy

Fujishita, Akira; Ishimaru, Tadayuki; Masuzaki, Hiroaki; Samejima, Teturou; Matsuwaki, Takahiro; Chavez, Raul Ortega; Yamabe, T

doi:10.1093/oxfordjournals.humrep.a135902

Cited by 8 publications

(3 citation statements)

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“…Comparada con la salpingostomía laparoscópica, esta metodología ha demostrado tener un éxito similar en cuanto a la disminución de b -hCG a largo plazo, sin embargo demora más tiempo en negativizarse. Ha demostrado una tasa de embarazo intrauterino significativamente más alta, y sin diferencias significativas en la recurrencia de EE 35,38,39,40 .…”

Section: B) Manejo Médicounclassified

Actualización del enfrentamiento y manejo del embarazo ectópico tubario

Rivera

Pomés

Díaz³

et al. 2020

Rev. chil. obstet. ginecol.

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Introducción y objetivos: El embarazo ectópico es una condición potencialmente mortal, con una incidencia del 1 al 2%. El 97% se produce en las tubas uterinas, y el 80% de éstos se encuentran en la región ampular. El objetivo de esta revisión es exponer una actualización del enfrentamiento y manejo del embarazo ectópico tubario. Métodos: Mediante el uso de la base de datos Epistemonikos, Scielo, Cochrane y Pubmed, se revisó la literatura existente sobre embarazo ectópico tubario. Resultados: El diagnóstico de embarazo ectópico tubario implica una combinación de síntomas clínicos, serología y ultrasonido. El manejo médico es una opción segura y efectiva en la mayoría de las pacientes hemodinámicamente estables. En caso de fracaso de tratamiento médico, paciente incapaz de mantener seguimiento, embarazo ectópico roto o embarazo heterotópico, debe ser manejado con tratamiento quirúrgico idealmente por laparoscopía. Independiente del tratamiento utilizado, existe gran probabilidad de éxito y escasas complicaciones. Conclusiones: Esta actualización describe la incidencia, factores de riesgo, diagnóstico, y manejo del embarazo ectópico tubario. Es importante un diagnóstico y tratamiento temprano, para reducir complicaciones asociadas a esta patología.

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Section: B) Manejo Médicounclassified

Actualización del enfrentamiento y manejo del embarazo ectópico tubario

Rivera

Pomés

Díaz³

et al. 2020

Rev. chil. obstet. ginecol.

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“…Given that similar results have been achieved with prophylactic systemic MTX treatment, an IM injection may be preferable. 65 DIFFERENT PREPARATION TECHNIQUES Based on the high number of persistent ectopics and tubal ruptures using laparoscopically guided injection of MTX mixed in saline, Fujishita et al 66 prospectively randomly assigned women to two ways of preparing MTX for injection into a tubal pregnancy. Twenty-six women with an intact tubal pregnancy < 5 cm in diameter with < 500 mL of blood in the pelvis had MTX dissolved either in saline or suspended in lipiodol with phosphatidylcholine added as a dispersing agent injected.…”

Section: Transcervical Deliverymentioning

confidence: 99%

Local Treatment of Ectopic Pregnancy

Raughley

Frishman²

2007

Semin Reprod Med

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The treatment of ectopic pregnancies has evolved from a purely surgical route with routine removal of the fallopian tube to one with multiple options. Medical treatment can be administered systemically or via local injection. Local delivery of chemotherapeutic agents is a safe and proven modality that is especially indicated for pregnancies in which a laparoscopic approach is not ideal and systemic therapy either has failed or is not desired. Local therapy has the potential to document immediately the cessation of fetal heart activity. Nontubal ectopic pregnancies may be ideally suited to local therapy, especially when there is a fetal heart present. Transvaginal ultrasound is the preferred mode for guidance and laparoscopic guidance has a limited role. Although a multitude of agents have been proposed, methotrexate, KCl, and hyperosmolar glucose are the most widely used and readily available. Local therapy has an important place in the armamentarium of the treatment of ectopic pregnancies.

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“…In an effort to find a more effective and safe method for the local injection of methotrexate, Fujishita et al (1995) prepared a suspension of methotrexate dissolved in lipidol with phosphatidylcholine added as a dispersing stabilizer to maintain the high tissue concentration and to prolong the effect. Their results showed that this suspension seems to be more effective than methotrexate solution alone.…”

Section: Local Methotrexatementioning

confidence: 99%

Extra-uterine pregnancy following assisted conception treatment

Abusheikha

Salha²,

Brinsden³

2000

Human Reproduction Update

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Ectopic pregnancy may be the only life-threatening disease in which prevalence has increased as mortality has declined. The most prominent theory to explain this phenomenon involves increased sensitivity of serum beta-human chorionic gonadotrophin (HCG) immunoassay and improved quality of transvaginal ultrasound, combined with a heightened awareness and increased suspicion of the condition among clinicians which has allowed early detection of ectopic pregnancy. Laparotomy, once the standard treatment of ectopic pregnancy, has been replaced almost entirely by operative laparoscopy. This is associated with a shorter hospital stay, fewer post-operative analgesic requirements, reduced costs and lower risk of adhesion formation. Laparotomy, however, remains necessary in cases with haemodynamic instability and with exceptional locations, e.g. cervical, abdominal and interstitial implantation. In selected cases, non-surgical management has also obtained high success rates. Among medical therapies, the most common is systemic or local administration of methotrexate. The other option is expectant management involving follow-up using serial serum HCG measurements and ultrasound scans. Thus, life-threatening ectopic pregnancy is now evolving into a medical disease, with the possibility of lower-cost treatment, faster recovery and higher subsequent fertility. In this review we assess the risk of extra-uterine implantation after assisted conception treatment, the accuracy of various diagnostic tools and focus on the efficacy, safety and the fertility outcomes of surgical and nonsurgical management of ectopic pregnancy.

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Local injection of methotrexate dissolved in saline versus methotrexate suspensions for the conservative treatment of ectopic pregnancy

Cited by 8 publications

References 0 publications

Actualización del enfrentamiento y manejo del embarazo ectópico tubario

Actualización del enfrentamiento y manejo del embarazo ectópico tubario

Local Treatment of Ectopic Pregnancy

Extra-uterine pregnancy following assisted conception treatment

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