Nonsurgical Treatment of Ectopic Pregnancy

Lipscomb, Gary H.; Stovall, Thomas G.; Ling, Frank W.

doi:10.1056/nejm200011023431807

Cited by 167 publications

(120 citation statements)

References 29 publications

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“…The overall success rate of single-dose methotrexate therapy in this study was 76.3%, which is similar to that reported in the literature, 65-96% (5-7, 11). Our study mostly confirms the results of previous studies (19,21,22) that noted a rate of treatment success of 88-100% in women with a decline in β-hCG between days 0 and 4, which is similar to our result (88.2%). Taken together, an early decline in serum β-hCG appears to be associated with a very high likelihood of successful treatment outcome.…”

Section: Discussionsupporting

confidence: 93%

“…Undoubtedly, women with a declining trend in the β-hCG level benefited from methotrexate treatment for EP. The results of this study are in accordance with previous reports (11,(19)(20)(21). Stika et al (13) demonstrated that the pretreatment β-hCG concentration was higher in women with treatment failure than those who were successfully treated with a single dose of MTX.…”

supporting

confidence: 93%

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Assessment of early decline in percentage of β-hCG values between days 0 and 4 after methotrexate therapy in ectopic pregnancy for prediction of treatment success

Çelik¹,

Türkçüoğlu²,

Karaer³

et al. 2013

J Turkish German Gynecol Assoc

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Objective: To evaluate percentage changes in serum beta-human chorionic gonadotropin (β-hCG) values between days 0-1, 0-4 and 0-7 as an indicator of methotrexate therapy success in extra-uterine pregnancies. Material and Methods:Women with ectopic pregnancy treated with single-dose methotrexate therapy between January 2011 and August 2012 were assessed. Recorded data were reviewed electronically from patient files. All women (n=93) with an ectopic pregnancy treated medically with intramuscular methotrexate (50 mg/m 2 ) were included. The percentage changes in serum β-hCG levels from day 0 to 1, day 0 to 4 and day 0 to 7 were calculated for each case. Results:The median β-hCG values decreased between days 0 and 4 by 55.8%, and 89.6% of these cases were treatment successes. The median initial serum β-hCG values were lower in women with successful treatment, but this was not statistically significant (p=0.11). Conclusion:A decline in serum β-hCG values between days 0 and 4 appears to be the best predictor. It would be beneficial to determine whether a woman with an ectopic pregnancy treated with singledose methotrexate administration will be treated successfully. (J Turkish-German Gynecol Assoc 2013; 14: 125-9) Key words: Ectopic pregnancy, human chorionic gonadotrophin, methotrexate.Received: 8 April, 2013 Accepted: 26 May, 2013 Amaç: Ektopik gebeliklerin tedavisinde methotraksat tedavisinin başarısını belirlemede beta-human koryonik gonadotropin (β-hCG) değerlerinin 0-1, 0-4 ve 0-7 günleri arasında yüzde değişimlerini değerlendirmek. Gereç ve Yöntemler:Ocak 2011 ile Agustos 2012 tarihleri arasında ektopik gebelik nedeniyle tanı alan ve tek doz metotreksat tedavisi alan 93 olgu çalışmaya dahil edildi. Elektronik ortamda kaydelilen hastaların dosyalarında bulunan tüm bilgiler incelendi. 0-1, 0-4 ve 0-7 günler arasındaki serum β-hCG seviyelerindeki değişim yüzdeleri her olgu için hesaplandı. Bulgular:Metotreksat tedavisinin başarılı olan olguların %55.8 ve %89.6'da ortanca β-hCG değerleri 0 ve 4. günler arasında azalmış olarak bulundu. Tedavi öncesindeki ortanca β-hCG seviyesi tedavinin başarılı olduğu olgularda daha düşük saptanmasına rağmen iki grup arasında istatistiksel olarak bir fark saptanmadı (p=0.11).Sonuç: Serum β-hCG değerlerindeki 0 ile 4. günler arasındaki düşme olması metoteksat tedavisinin başarısını tahmininde en iyi gösterge olarak ortaya çıkmaktadır, ve tek doz metotreksat ile tedavi edilen ektopik gebeliklerin nihai tedavinin başarısını belirlemek yararlı olacaktır. (J Turkish-German Gynecol Assoc 2013; 14: 125-9) Abstract Özet tion of MTX treatment success. The serum β-hCG level before MTX administration has been reported as a particular factor contributing significantly to treatment failure (8). Previously, it has been found that at least a 15% reduction in the β-hCG concentration on the seventh day compared to the fourth day after MTX administration is the best predictor of treatment success, with a positive predictive value of approximately 93.0% (9). A rise in the β-hCG titer on t...

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Section: Discussionsupporting

confidence: 93%

supporting

confidence: 93%

Assessment of early decline in percentage of β-hCG values between days 0 and 4 after methotrexate therapy in ectopic pregnancy for prediction of treatment success

Çelik¹,

Türkçüoğlu²,

Karaer³

et al. 2013

J Turkish German Gynecol Assoc

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“…But those patients cannot be exactly predicted and therefore cannot be counseled for repeating this single dose again [20]. Definitely, the expression "single-dose protocol" is not sure because it includes the opportunity of repeating the dose at weekly intervals in poor responders.…”

Section: Discussionmentioning

confidence: 99%

Double Versus Single Dose Methotrexate Regimens in Management of Undisturbed Ectopic Pregnancy

Saleh¹

2016

OGIJ

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Objective: To assess the effectiveness and safety of double-dose methotrexate in comparing to single-dose methotrexate for management of ectopic pregnancy. Methods:A prospective randomized-controlled trial was conducted on 200 patients with ectopic pregnancy at the Obstetrics and gynecological Departments of Zagazig University, Egypt between June, 20 11 to May 2014. Patients were randomized into two groups, (group 1) who received a single dose 50 mg per meters squared surface area methotrexate (50 mg/m 2 IM on day 1) intramuscularly or (group 2), who received double-dose methotrexate regimen (50 mg/m 2 intramuscularly on days 1 and 4). The outcomes were; success rate, time duration of fall down of b-hcg to < 15 mlU/mL and undesirable effects of methotrexate. Results:In general, there is significant differences between both groups as regard the success rate and the duration of fall down β-hCG. The success rate was better in group 2 than in group 1 (90% versus 78.75%, P=0.01). The duration of fall down β-hCG until < 15 mlU/mL was shorter in group 2 (P=0.01). There was no significant difference between groups in adverse effects.Conclusion: Double-dose methotrexate as one of regimens of medical management of undisturbed ectopic pregnancy had more effectiveness and success rate than that of single-dose regimen with equivalent safety.

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“…The incidence also increased from 1.9 % to 2.3 % of livebirths between 1981 and 1991 in the United States (Berg, 1999). In another study conducted in the United States, the annual incidence of ectopic pregnancy increased from 0.37 % of pregnancies in 1948 to 1.97 in 1992 (Lipscomb et al, 2000). At the Royal Commission Medical Centre, Yanbe Industrial city in the Kingdom of Saudi Arabia the incidence between 2005 to 2008 was found to be 1 in 171 deliveries that is 0.58 % (Aziz et al, 2011).…”

Section: Incidence Of Ectopic Pregnancymentioning

confidence: 99%

Management and Outcome of Ectopic Pregnancy in Developing Countries

Dabota¹

2011

Ectopic Pregnancy - Modern Diagnosis and Management

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Nonsurgical Treatment of Ectopic Pregnancy

Cited by 167 publications

References 29 publications

Assessment of early decline in percentage of β-hCG values between days 0 and 4 after methotrexate therapy in ectopic pregnancy for prediction of treatment success

Assessment of early decline in percentage of β-hCG values between days 0 and 4 after methotrexate therapy in ectopic pregnancy for prediction of treatment success

Double Versus Single Dose Methotrexate Regimens in Management of Undisturbed Ectopic Pregnancy

Management and Outcome of Ectopic Pregnancy in Developing Countries

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