Objectives To review our experience in medical treatment with Methotrexate (MTX) for tubal ectopic pregnancy (EP) from 2000 to 2013. Methods Among 402 cases of tubal EP treated at University Hospital of Parma we retrospectively collected those treated with systemic single-dose MTX. Informations concerning the location and the diameter of the gestational sac or tubal ring, the presence or absence of yolk sac and embryo and embrionic hearth activity were recorded. Following data have been analyzed: hCG levels, features and location of the EP. We considered eligible for medical treatment patients with baseline hCG levels below 5000 mUI/mL, pregnancy diameter <40 mm at ultrasound and increasing hCG levels after 48 hours from the previous blood test; we also administered MTX to 14 patients with hCG levels above 5000 mUI/mL who refused primary laparoscopic approach. Statistycal analysis was performed with the software IBM SPSS STATISTICS VERS. 20. Results The location of tubal pregnancy was in the right salpinx in 225 patients (55.9%) and in the left salpinx in 177 patients (44.1%) (p >0,05). Tubal ring diameter was recorded in 258 cases, ranging from 6 mm and 49 mm, a mean value of 23.23±10.77 mm, a median value of 21 mm and 95% CI 21.91-24.55 mm. 56 (13.9%) of 65 patients were successfully treated with systemic MTX (failure rate 13.8%). Kruskall-Wallis test found no difference in tubal ring diameter between patients successfully treated with MTX (mean value 19.19 mm) and patients in whom medical treatment failed (mean value 20.25 mm), whereas hCG level was significantly lower in the successfully treated patients (mean value 2282.77 mUI/mL vs mean value 6177.37 mUI/mL) (p<0,05). 7 of the 9 patients in whom medical treatment failed had hCG levels above 5000 mUI/mL. Conclusions In eligible patients MTX single-dose is safe and effective. According to our data hCG levels, but not tubal ring diameter, can be used as a predictor of success of medical treatment.

Medical treatment for tubal ectopic pregnancy: ourexperience from 2000 to 2013 / Dall'Asta, Andrea. - In: ULTRASOUND IN OBSTETRICS & GYNECOLOGY. - ISSN 0960-7692. - ELETTRONICO. - (2014). ((Intervento presentato al convegno 24th World Congress on Ultrasound in Obstetrics and Gynecology tenutosi a Barcellona nel Settembre 2014.

Medical treatment for tubal ectopic pregnancy: ourexperience from 2000 to 2013.

Andrea Dall'Asta
Membro del Collaboration Group
2014

Abstract

Objectives To review our experience in medical treatment with Methotrexate (MTX) for tubal ectopic pregnancy (EP) from 2000 to 2013. Methods Among 402 cases of tubal EP treated at University Hospital of Parma we retrospectively collected those treated with systemic single-dose MTX. Informations concerning the location and the diameter of the gestational sac or tubal ring, the presence or absence of yolk sac and embryo and embrionic hearth activity were recorded. Following data have been analyzed: hCG levels, features and location of the EP. We considered eligible for medical treatment patients with baseline hCG levels below 5000 mUI/mL, pregnancy diameter <40 mm at ultrasound and increasing hCG levels after 48 hours from the previous blood test; we also administered MTX to 14 patients with hCG levels above 5000 mUI/mL who refused primary laparoscopic approach. Statistycal analysis was performed with the software IBM SPSS STATISTICS VERS. 20. Results The location of tubal pregnancy was in the right salpinx in 225 patients (55.9%) and in the left salpinx in 177 patients (44.1%) (p >0,05). Tubal ring diameter was recorded in 258 cases, ranging from 6 mm and 49 mm, a mean value of 23.23±10.77 mm, a median value of 21 mm and 95% CI 21.91-24.55 mm. 56 (13.9%) of 65 patients were successfully treated with systemic MTX (failure rate 13.8%). Kruskall-Wallis test found no difference in tubal ring diameter between patients successfully treated with MTX (mean value 19.19 mm) and patients in whom medical treatment failed (mean value 20.25 mm), whereas hCG level was significantly lower in the successfully treated patients (mean value 2282.77 mUI/mL vs mean value 6177.37 mUI/mL) (p<0,05). 7 of the 9 patients in whom medical treatment failed had hCG levels above 5000 mUI/mL. Conclusions In eligible patients MTX single-dose is safe and effective. According to our data hCG levels, but not tubal ring diameter, can be used as a predictor of success of medical treatment.
Medical treatment for tubal ectopic pregnancy: ourexperience from 2000 to 2013 / Dall'Asta, Andrea. - In: ULTRASOUND IN OBSTETRICS & GYNECOLOGY. - ISSN 0960-7692. - ELETTRONICO. - (2014). ((Intervento presentato al convegno 24th World Congress on Ultrasound in Obstetrics and Gynecology tenutosi a Barcellona nel Settembre 2014.
File in questo prodotto:
Non ci sono file associati a questo prodotto.

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11381/2857222
Citazioni
  • ???jsp.display-item.citation.pmc??? ND
  • Scopus ND
  • ???jsp.display-item.citation.isi??? ND
social impact