Pregnancy of Unknown Location: A Survey-Based Evaluation of When and Why Physicians Intervene?

Faden, Majed S.; Khayat, Suhaib; Brown, Richard N

doi:10.1016/j.jogc.2017.01.007

Cited by 3 publications

(5 citation statements)

References 12 publications

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“…The decision to intervene with MTX may be taken prematurely and could expose a developing IUP to a teratogenic agent, resulting in earlier gestational age at birth, lower birth weight and birth defects 14 . In a survey of Canadian obstetricians and gynecologists, 40% of participants reported cases in which MTX was administered to a suspected EP that was identified subsequently as an IUP 12 . In addition, patients with a low risk of EP could be overtreated and experience unnecessary side effects of MTX, such as headache, dizziness, nausea, vomiting and diarrhea 15 .…”

Section: Introductionmentioning

confidence: 99%

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Safety of methotrexate administration in women with pregnancy of unknown location at high risk of ectopic pregnancy

Jin,

Uzuner,

Condous

2024

Ultrasound in Obstet & Gyne

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ObjectivesThis study evaluates the safety of current guidelines on methotrexate (MTX) administration in women with pregnancy of unknown location (PUL) who are considered to have high risk of underlying ectopic pregnancy (EP) and to investigate whether this would result in inadvertent exposure of MTX to viable intra‐uterine pregnancy (IUP).MethodsA retrospective observational study was conducted on clinically stable women who were classified PUL at Early Pregnancy Unit, Nepean Hospital, between 2007 and 2021. PUL is defined as when a woman presents with a positive pregnancy test but has no signs of IUP or EP on the transvaginal ultrasound (TVS). If patients with a PUL behave biochemically like an EP but the location is not confirmed on ultrasound, these women are eligible for MTX to minimize the risk of subsequent tubal rupture. Criteria discussed in the guidelines of American College of Obstetricians and Gynaecologists (ACOG), American Society for Reproductive Medicine (ASRM), Royal College of Obstetricians & Gynaecologists (RCOG) and National Institute for Health Care Excellence (NICE) were applied to the collected PUL database. The number of patients eligible to receive MTX and the number of women with underlying viable IUP who would be inadvertently given MTX were calculated.ResultsA total of 816 consecutive women with PUL were reviewed, and 724 had complete data and were included in the final analysis. 6 patients were persistent PULs, and 718 fell among outcomes of 4 subgroups: viable IUP, non‐viable IUP, EP, failed PUL. According to the ACOG, ASRM, RCOG and NICE, the rate of possible MTX administration among patients with a PUL is 2.76%, 4.56%, 0.41% and 35.36%, respectively. However, no single persistent‐PUL would have received MTX according to the above protocols, and majority of the MTX treatment were unnecessary because those patients were classified as NVIUP or FPUL later. More importantly, ACOG and ASRM could theoretically result in inadvertent MTX administration to women with an underlying IVUP at rates of 4.1/1000 (3/724).ConclusionsCurrent guidelines used to predict high risk of EP among PUL population are not safe enough to avoid inadvertent MTX administration to women with an underlying viable IUP. These guidelines need to be wisely used to ensure that no wanted pregnancy is exposed to MTX. Women with PULs should be carefully monitored and MTX should be used with judicious care when the location of pregnancy is yet to be confirmed.This article is protected by copyright. All rights reserved.

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Section: Introductionmentioning

confidence: 99%

“…Medical intervention, commonly in the form of methotrexate (MTX), may be considered to treat asymptomatic PUL that is at risk of being an EP [10][11][12][13] . However, prediction of high-risk pregnancy is not error-free.…”

Section: Introductionmentioning

confidence: 99%

Safety of methotrexate administration in women with pregnancy of unknown location at high risk of ectopic pregnancy

Jin,

Uzuner,

Condous

2024

Ultrasound in Obstet & Gyne

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“…A Gravidez de Local Desconhecido (PUL) refere-se a qualquer gravidez que apresente um teste de gravidez positivo, porém, com ausência de evidência de saco gestacional em ultrassonografia 1 . Sua prevalência representa em torno de 2% de todas as gestações, contudo, é responsável por 9% de todas os óbitos maternos relacionados à gestação 2 , sendo a principal causa de mortalidade materna no primeiro trimestre 3 .…”

Section: Introductionunclassified

“…A PUL apresenta grande variabilidade em seu manejo na prática ginecológica 3 . Diante dessa condição, a conduta pode ser expectante, clínica, cirúrgica ou uma associação dessas abordagens, com necessidade sempre de ser individualizada a depender das características da paciente 4 .…”

Section: Introductionunclassified

Gravidez De Local Desconhecido Persistente E Conduta Expectante: Relato De Caso

Padilha,

Drun,

Lohn

et al. 2023

Rev. Contemp.

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A Gravidez de Local Desconhecido (PUL) refere-se a qualquer gravidez com um teste de gravidez positivado, porém, sem evidência de saco gestacional em ultrassonografia1 A PUL apresenta grande variabilidade em seu manejo e é a principal causa de mortalidade materna no primeiro trimestre2. Este caso destaca a importância de um acompanhamento rigoroso e com a possibilidade da conduta expectante segura.

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“…[8][9][10][11] Pregnancy of unknown location (PUL) is the preferred terminology when the serum hCG is positive, but no signs of intrauterine or extrauterine pregnancy can be detected using transvaginal ultrasonography. 12 Appropriate management of EP is crucial to prevent patient mortality and morbidity related to EP rupture. 2,13 Methotrexate (MTX), which is a folinic acid antagonist, has been used as a first-step therapy in the treatment of EP for years.…”

Section: Introductionmentioning

confidence: 99%

Methotrexate Therapy for Ectopic Pregnancies: A Tertiary Center Experience

Özyüncü

Duru

Beksaç

2018

Rev Bras Ginecol Obstet

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Objective Our aim is to demonstrate the importance of methotrexate (MTX) therapy for the treatment of ectopic pregnancy (EP). Methods This retrospective study consisted of 99 patients (72 tubal EPs, 20 pregnancies of unknown location (PUL), 4 cesarean section (CS) scar EPs and 3 cervical EPs) treated with MTX. Results Methotrexate therapy was successful in 68.5% of EPs. There were statistically significant differences between the MTX success and failure groups based on ultrasonographic findings, patient complaints, gestational week and serum human chorionic gonadotropin (hCG) values. The MTX success rates in PUL and tubal pregnancies were 95% and 61.1%, respectively. The MTX success rates in single-dose, two-dose and multi-dose protocol groups were 86.9%, 28.6% and 40%, respectively. All cervical and CS scar ectopic pregnancies were treated successfully with MTX therapy. Conclusion Methotrexate might be the first-line treatment option for EPs under certain conditions. Physicians must be more cautious in cases with higher hCG values, the presence of abdominal-pelvic pain, the presence of fetal cardiac activity, larger gestational sac (GS) diameters, and more advanced gestational weeks according to the last menstrual period.

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Pregnancy of Unknown Location: A Survey-Based Evaluation of When and Why Physicians Intervene?

Cited by 3 publications

References 12 publications

Safety of methotrexate administration in women with pregnancy of unknown location at high risk of ectopic pregnancy

Safety of methotrexate administration in women with pregnancy of unknown location at high risk of ectopic pregnancy

Gravidez De Local Desconhecido Persistente E Conduta Expectante: Relato De Caso

Methotrexate Therapy for Ectopic Pregnancies: A Tertiary Center Experience

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