Systemic treatment of ectopic pregnancies with single-dose methotrexate

Schäfer, D.; Kryss, J.; Pfuhl, J.-P.; Baumann, R.

doi:10.1016/s1074-3804(05)81012-6

Cited by 16 publications

(7 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The majority of patients with an ectopic pregnancy at the time of admission to the hospital usually have complained about pain and pain with bleeding. 7,23,31 In the current study, as well, the majority of patients complained about pain and pain with bleeding, and about 9.1% of patients had no symptoms, as reported in other studies. [32][33][34] TVS has reformed the assessment of patients with early pregnancy problems as many diagnostic features can be easily visualized by TVS.…”

Section: Discussionsupporting

confidence: 87%

“…[19][20][21] A previous meta-analysis estimated the success rate of a single dose MTX regimen to be 88.1%. 7 The high success rate has been attributed to the fact that only women with a good prognosis underwent treatment with a single dose. The success rate of this study is towards the lower end of the previous studies.…”

Section: Discussionmentioning

confidence: 99%

“…All three regimes are effective and generally safe with studies involving treatment with MTX therapy have reported pregnancy rates of 79.6-100%. [7][8][9][10][11] The serum level of beta-human chorionic gonadotropin (β-HCG) plays an important role in conjunction with the findings of transvaginal ultrasonography (TVS) in the diagnostic evaluation of ectopic pregnancy and pregnancy of unknown location (PUL) which is defined as the situation when the pregnancy test is positive, but there are no signs of intrauterine pregnancy or an extrauterine pregnancy via TVS. 12 TVS may help in identifying ectopic pregnancy by observance of small masses (about 10 mm in diameters) in the adnexa and detailed evaluation of its character, the endometrial cavity contents as well as the presence of free peritoneal fluid.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The Use of Single Dose Methotrexate in the Management of Ectopic Pregnancy and Pregnancy of Unknown Location: 10 Years’ Experience in a Tertiary Center

Sindiani¹,

Alshdaifat²,

Obeidat³

et al. 2020

IJWH

View full text Add to dashboard Cite

Objective To study factors associated with the success of single dose methotrexate (MTX) treatment in women with ectopic pregnancy. Methods This is a retrospective study of women (n=110) with ectopic pregnancy and treated with single dose of MTX. The clinical presentations, transvaginal sonography (TVS) findings, pretreatment beta-human chorionic gonadotropin (β-HCG), and progesterone values were compared between the treatment success (Group S) and treatment failure (Group F) groups. Results The overall success rate of treatment with single dose of MTX was 75.45%. The majority of patients in both groups presented with pain and bleeding (~55%), and bleeding only was the presenting symptom in about 20% of patients. Only 3 patients (3.61%) in Group S required a repeat dose of MTX. In contrast, 51.8% of the Group F patients required a repeat dose. The mean pretreatment β-HCG level was 2.3 times higher in Group F than in Group S (1734±1684 vs 4036±2940 IU/L). The data showed a β-HCG level of 3924IU/L as a suitable cut-off value with 76.19% sensitivity and 62.5% specificity to predict MTX treatment success. History of ectopic pregnancy had no relation with success/treatment failure or a repeat dose. None of the TVS findings were related to the outcome of the treatment, whereas pretreatment HCG level was a significant predictor. Conclusion The single dose MTX treatment was successful in 75.45% (83/110) of cases, with 3.61% (3/83) requiring a repeat dose of the drug. Pretreatment β-HCG level is a significant predictor of the treatment outcome.

show abstract

Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The Use of Single Dose Methotrexate in the Management of Ectopic Pregnancy and Pregnancy of Unknown Location: 10 Years’ Experience in a Tertiary Center

Sindiani¹,

Alshdaifat²,

Obeidat³

et al. 2020

IJWH

View full text Add to dashboard Cite

show abstract

“…In addition, the incidence of MTX‐related side effects decreased by 50% in the lower‐dose group. In another study, Schἄfer et al . compared single‐dose 20 mg/m 2 versus 40 mg/m 2 MTX regimen in 40 patients with ectopic pregnancy and reported an overall success rate of 92.5%.…”

Section: Discussionmentioning

confidence: 99%

Comparative study of low‐dose versus standard single‐dose methotrexate: A novel approach for medical treatment of ectopic pregnancy

Aydın

Özgen

Yavuz

2020

J of Obstet and Gynaecol

View full text Add to dashboard Cite

Aim: Methotrexate (MTX) treatment at a dose of 50 mg/m 2 of body surface area (BSA) is an effective and widely used treatment method in ectopic pregnancy. However, there is a limited number of studies investigating lower MTX doses. In this study, we aimed to investigate the efficacy of lower MTX doses in the treatment of ectopic pregnancy. Methods: This retrospective study included a total of 112 patients who were hospitalized due to ectopic pregnancy and administered single-dose MTX. The patients were divided into three groups according to the dose given as 22-40 mg/m 2 of BSA (n = 17), 41-49 mg/m 2 of BSA (n = 81) and ≥ 50 mg/m 2 of BSA (n = 14). Data including demographic characteristics of the patients, previous history of ectopic pregnancy, previous gynecological surgeries, the use of in vitro fertilization techniques, ultrasonographic findings, beta-human chorionic gonadotropin hormone (β-hCG) levels, pre-treatment endometrial sampling, MTX doses applied, and the need for a surgical intervention during follow-up were retrieved from the hospital records. Results: Of the patients, 16.96% (n = 19) were operated at the end of treatment, irrespective of the pretreatment β-hCG levels with a success rate of 83% (n = 93). Fourteen (12.5%) of the patients received the second dose of MTX. The overall success rate was 89.2% in patients with a β-hCG level of ≤5000 mIU/mL. Conclusion: This study shows that lower MTX doses than 50 mg/m 2 , which has been considered standard treatment and widely used in the treatment of ectopic pregnancy for nearly three decades, are effective with similar success rates.

show abstract

“…Longer term economic outcomes after the treatment of tubal pregnancy, such as the need for assisted conception, also need to be considered 25,26 . Tubal patency rates in excess of 80% have been reported in uncontrolled studies of single dose methotrexate therapy 9,27,28 . However, the only randomised trial to report tubal patency rates after methotrexate and laparoscopic salpingotomy found no difference between medical and surgical treatment 24 .…”

Section: Discussionmentioning

confidence: 99%

An economic evaluation of single dose systemic methotrexate and laparoscopic surgery for the treatment of unruptured ectopic pregnancy

Sowter

Farquhar

Gudex

2001

BJOG

View full text Add to dashboard Cite

Objective To compare the direct and indirect costs of single dose systemic methotrexate with laparoscopic surgery for the treatment of unruptured ectopic pregnancy.Design A cost minimisation study undertaken alongside a randomised trial. Setting Departments of Obstetrics and Gynaecology in three hospitals in Auckland, New Zealand.Participants Sixty-two women with an ectopic pregnancy randomised to treatment with either a single dose of methotrexate (50mg/m 2 ) or laparoscopic surgery.Main outcome measures Direct and indirect costs based on the results of the randomised trial.Results Direct costs per case were signi®cantly lower in the methotrexate group (mean $NZ 1470) than in the laparoscopy group (mean $NZ 3083) with a mean difference of $NZ 1613 (95% CI $NZ 1166 -$NZ 2061). These signi®cant differences existed under a wide range of alternative assumptions about unit costs. The difference in direct costs in favour of methotrexate was greatest for women presenting with low pretreatment serum b-hCG concentrations. Mean indirect costs were also signi®cantly lower in the methotrexate group (mean $NZ 1141) than in the laparoscopy group (mean $NZ 1899) with a mean difference of $NZ 758 (95% CI $NZ 277 -$NZ 1240). For women presenting with pretreatment serum b-hCG concentrations of over 1500 IU/ L this difference in indirect costs is lost due to the prolonged follow up required and a higher rate of surgical intervention in women receiving methotrexate.Conclusion This economic evaluation shows that treating suitable women with an ectopic pregnancy using systemic methotrexate therapy results in a signi®cant reduction in direct costs. The indirect costs borne by the woman and her carers are only likely to be reduced in women with pretreatment serum b-hCG concentrations under 1500 IU/L.

show abstract

Systemic treatment of ectopic pregnancies with single-dose methotrexate

Cited by 16 publications

References 19 publications

The Use of Single Dose Methotrexate in the Management of Ectopic Pregnancy and Pregnancy of Unknown Location: 10 Years’ Experience in a Tertiary Center

The Use of Single Dose Methotrexate in the Management of Ectopic Pregnancy and Pregnancy of Unknown Location: 10 Years’ Experience in a Tertiary Center

Comparative study of low‐dose versus standard single‐dose methotrexate: A novel approach for medical treatment of ectopic pregnancy

An economic evaluation of single dose systemic methotrexate and laparoscopic surgery for the treatment of unruptured ectopic pregnancy

Contact Info

Product

Resources

About