Prognostic factors for successful expectant management of ectopic pregnancy

Trio, Diego; Strobelt, Nicola; Picciolo, C.; Lapinski, Robert; Ghidini, Alessandro

doi:10.1016/s0015-0282(16)57410-x

Cited by 104 publications

(66 citation statements)

References 8 publications

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“…Resolution rates for expectant management of ectopic pregnancy were as high as 88% when initial serum hCG was less than 200 U/l-similar resolution rates were also seen when the initial serum hCG was less than 1000 U/l [9,10].…”

Section: Role Of Expectant Management In Ectopic Pregnancymentioning

confidence: 66%

The management of ectopic pregnancies and pregnancies of unknown location

2004

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Since the introduction of dedicated Early Pregnancy Units and the use of high-resolution transvaginal probes ectopic pregnancies are diagnosed at earlier gestations. As a result, the treatment options in the management of ectopic pregnancies have diversified. In this review, the role of transvaginal sonography in the management of women with ectopic pregnancies is described and the different treatment modalities available in their management are critically evaluated. We assert that ectopic pregnancy should be diagnosed on the basis of positively visualising an adnexal mass using transvaginal sonography, rather than the absence of an intrauterine pregnancy. If a pregnancy cannot be seen, either inside or outside the uterus, this should be described as a pregnancy of unknown location and managed expectantly until the outcome is confirmed.

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Section: Role Of Expectant Management In Ectopic Pregnancymentioning

confidence: 66%

The management of ectopic pregnancies and pregnancies of unknown location

2004

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“…Bu yaklaşımda başarı oranının %47-%82 arasında olduğu bildirilmiştir (27). Ayrıca bekle-gör yaklaşımında β-hCG düzeylerinin 1000 mIU/ml'nin altında olması, 3 cm'den küçük gebelik kesesinin olması ve fetal kalp atımlarının görülmemesi önerilen kriterlerdir (27,28). Çalışma olgularımızdaki 26 olguya bekle-gör yaklaşımı uygulandı.…”

Section: Discussionunclassified

Laboratory? or Fertility? in Ectopic Pregnancy Management

Elçi¹,

Elçi²,

Çim³

et al. 2017

Van Med J

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ÖZETAmaç: Bu çalışmanın amacı kliniğimizde son üç yılda ektopik gebelik tanısı ile tedavi edilen olguların tanı ve tedavi yaklaşımlarının irdelenerek tedavi başarı oranlarımızın belirlenmesidir. Yöntem ve Gereçler:Haziran 2013-Kasım 2016 tarihleri arasında ektopik gebelik nedeniyle tedavi edilen 140 olgunun bilgilerine ulaşılabilen 111 olgu yaş, gravida, yaşayan çocuk sayısı, önceki gebeliği, kontrasepsiyon yöntemi, pelvik cerrahi öyküsü, hemodinamik stabilite, başlangıç β-hCG düzeyi, ultrasonografide batında serbest sıvı bulunup-bulunmadığı, adneksial alanda bulgu varlığı, bekle-gör yöntemi, methotrexate (MTX) ve cerrahi tedavi edilen olgu sayısı retrospektif olarak değerlendirildi. Bulgular:Olguların yaş ortalaması 29±5,6, obstetrik öykülerinde; önceki gebelikleri abortus %12,6 (n=14), sezaryen ile doğum %12,6 (n=14), vajinal yol ile doğum %39,6 (n=44) idi. Daha önceki gebeliğinde ektopik cerrahisi geçirme oranı %3,6 (n=4) ve olguların %17,1'inde (n=19) geçirilmiş pelvik cerrahi öyküsü vardı. İlk başvuruda olguların %21,6'sında (n=24) hipovolemik bulgular mevcuttu, %78,4 olgunun (n=87) hemodinamisi stabil ve ektopik gebelik rüptür bulguları yoktu. Bu olguların ilk yaklaşımlarında ise, %23,4'ü (26) sadece izlenirken (bekle-gör), %55'ine (n=61) medikal tedavi, %21,6'sına (n=24) cerrahi tedavi uygulandı. Bekle-gör yaklaşımında bulunulan olgularda başarı oranı %77, tek doz MTX tedavisinin başarı oranı %64 bulundu. Methotrexate tedavisi alan 2 olguda 2.doz MTX ile başarı elde edilemeyince cerrahi tedavi uygulandı. Cerrahi tedavi uygulanan 52 olgudan %75'ine (n=39) salpenjektomi, %19,2'sine (n=10) salpingostomi, %2'sine (n=1) salpingotomi ve %3,8'ine (n=2) overyal wedge rezeksiyon yapıldı.Sonuç: Rüptür bulguları olmayan, genel durumu stabil hastalarda methotrexate ve bekle-gör tedavisi ilk seçenek olarak önerilebilir. Cerrahi tedavi genellikle genel durum ve fertilite durumu düşünülerek tercih edilmeli ve tedavide organ koruyucu cerrahi ön planda tutulmalıdır.Anahtar Kelimeler: Ektopik gebelik, methotrexate, bekle-gör tedavisi, cerrahi tedavi ABSTRACT Objective: The aim of this study is to evaluate diagnostic and treatment modalities with our treatment success rates of patients treated due to ectopic pregnancy. Materials and Method:111 out of 140 patients treated due to ectopic pregnancy whose information could be accessed were evaluated considering; age, gravidity, contraceptive method, history of pelvic surgery, hemodinamically stability, first β-hCG values, presence of free abdominal fluid, ultrasonographic findings suggesting adnexal masses, the number of treatment approaches as wait and see, Methotrexate and surgery in time period between June 2013 and December 2016.Results: Mean age of the patients was 29-5,6, previous pregnancies with abortion 12,6%, cesarean 39,6%, vaginal delivery 3,6%, previous surgery due to ectopic pregnancy 17,1%. 21,6% of the patients were with hypovolemic findings and 78,4% of the patients were hemodynamically stable without rupture findings in the first attendance. In initial managem...

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“…However, indication for expectant management is not yet standardized. Some investigators suggested that the initial serum level of hCG (1000 mIU/ml [4][5][6] to 2000 [7] mIU/ml) is a predictive factor for the success of expectant management. Furthermore, Korhonen [8] reported that longitudinal changes in hCG level might be predictive of successful expectant management.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, Korhonen [8] reported that longitudinal changes in hCG level might be predictive of successful expectant management. It has been reported that 50-70% [4][5][6][7][8] of expectant management cases are successful. In our study, 54% of enrolled expectant management cases were completed uneventfully, consistent with previous reports.…”

Section: Discussionmentioning

confidence: 99%

Retrospective analysis of laparoscopic salpingostomy and conservative expectant management of tubal ectopic pregnancy

Takashima

Yoshida

Murase

et al. 2009

Reprod Medicine & Biology

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Purpose To identify predictive factors for successful expectant management of ectopic pregnancy and to evaluate the prognosis for fertility after expectant management and laparoscopic salpingostomy. Methods Forty-six cases of expectant management and eighty cases of laparoscopic salpingostomy for tubal ectopic pregnancy were retrospectively analyzed. Subjects were classified in three groups: those who underwent laparoscopic salpingostomy, those treated by expectant management only, and those treated by expectant management but requiring additional treatment. Results The rates of tubal patency, intrauterine pregnancy and repeated ectopic pregnancy in the laparoscopic salpingostomy group were 75, 40, and 16%. The rates in the expectant management group were not significantly different: 72, 42 and 15%. Finally, the rates in the extra treatment group were 75, 39 and 15%. Success rate of expectant management was 54%. In 93% of cases expectant management was successfully completed when the initial levels of urinal hCG were less than 3000 mIU/ml and the levels of hCG 48 h later were less than 80% of the initial levels. However, expectant management alone was insufficient and required extra treatment in 90% of cases when the initial levels of hCG were 3000 mIU/ml and above or when the levels of hCG level 48 h later was 80% of initial levels and above. Conclusions Expectant management in combination with salpingostomy is not only minimally invasive but also a useful way to preserve fertility. Initial urine hCG levels and their variation over time can help predict whether expectant management will succeed.

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Prognostic factors for successful expectant management of ectopic pregnancy

Cited by 104 publications

References 8 publications

The management of ectopic pregnancies and pregnancies of unknown location

The management of ectopic pregnancies and pregnancies of unknown location

Laboratory? or Fertility? in Ectopic Pregnancy Management

Retrospective analysis of laparoscopic salpingostomy and conservative expectant management of tubal ectopic pregnancy

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