“…The diagnosis of ectopic pregnancy was based on the absence of an intrauterine pregnancy and on the demonstration of tubal ectopic pregnancy when a gestational sac with a yolk sac, or embryo, or both is noted in the adnexa on US with abnormal β‐hCG levels. In the definition of abnormal β‐hCG levels, the pattern of rise or fall in β‐hCG after 48 h is considered: an increase less than 66% or a decrease more than 15% …”
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.
“…The diagnosis of ectopic pregnancy was based on the absence of an intrauterine pregnancy and on the demonstration of tubal ectopic pregnancy when a gestational sac with a yolk sac, or embryo, or both is noted in the adnexa on US with abnormal β‐hCG levels. In the definition of abnormal β‐hCG levels, the pattern of rise or fall in β‐hCG after 48 h is considered: an increase less than 66% or a decrease more than 15% …”
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.
“…2) is highly suggestive of an ectopic pregnancy [95, 96]. If a suspicious mass moves separately from the ovary—called the ‘blob’ sign - the positive predictive value is above 90 % in a symptomatic woman with a positive serum b-hCG and no IUP on transvaginal ultrasound [97, 98]. Fig.…”
BackgroundEctopic pregnancy is a potentially life-threatening condition occurring in 1-2 % of all pregnancies. The most common ectopic implantation site is the fallopian tube, though 10 % of ectopic pregnancies implant in the cervix, ovary, myometrium, interstitial portion of the fallopian tube, abdominal cavity or within a cesarean section scar.FindingsDiagnosis involves a combination of clinical symptoms, serology, and ultrasound. Medical management is a safe and effective option in most clinically stable patients. Patients who have failed medical management, are ineligible, or present with ruptured ectopic pregnancy or heterotopic pregnancy are most often managed with excision by laparoscopy or, less commonly, laparotomy. Management of nontubal ectopic pregnancies may involve medical or surgical treatment, or a combination, as dictated by ectopic pregnancy location and the patient's clinical stability. Following tubal ectopic pregnancy, the rate of subsequent intrauterine pregnancy is high and independent of treatment modality.ConclusionThis review describes the incidence, risk factors, diagnosis, and management of tubal and non-tubal ectopic and heterotopic pregnancies, and reviews the existing data regarding recurrence and future fertility.
“…Clinical and laboratory data were extracted from a prospectively maintained departmental database; key parameters (oocyte and recipient ages, obstetrical history, hCG values, imaging results, MTX treatments, surgical reports, and clinical outcomes) were directly verified in the electronic medical record. Ectopic pregnancies were diagnosed by an abnormal hCG trend (hCG rise less than 53% or fall less than 15% in 48 h), with either the absence of ultrasound evidence of intrauterine pregnancy and negative endometrial sampling or definitive ultrasound evidence of tubal ectopic pregnancy, including a yolk sac or embryo in the adnexa [2,22,23]. In rare cases, patients refused endometrial sampling in the setting of persistently elevated, abnormally trending hCG measurements, without definitive ultrasound evidence of ectopic pregnancy, and were given methotrexate following counseling regarding this protocol departure.…”
This is the first study to report that in women with ectopic pregnancies after IVF, higher hCG-though well below treatment failure thresholds previously described in spontaneous pregnancies-fewer embryos transferred, and adnexal masses are associated with greater odds of failing one dose of MTX. These findings can be used to counsel IVF patients regarding the likelihood of success with single-dose MTX.
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