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Medical Treatment Ectopic Pregnancy

Jin-Sung Yuk, Jung Hun Lee, Won I Park, Hyeong Sik Ahn, Hyun Jung Kim
BACKGROUND: It remains unclear which methotrexate protocol for the treatment of ectopic pregnancy has a higher success rate or a higher adverse effect rate. OBJECTIVE: To compare the treatment success rates and adverse effect rates of single-dose and non-single-dose (two-dose and multi-dose) methotrexate protocols in the treatment of ectopic pregnancy. SEARCH STRATEGY: Various databases including Medline, Embase, and the Cochrane Central Register of Controlled Trials were searched on July 1, 2017, using search terms including "methotrexate" and "pregnancy...
February 27, 2018: International Journal of Gynaecology and Obstetrics
Roxanne Hastie, Elgene Lim, Pavel Sluka, Lisa Campbell, Andrew W Horne, Lenore Ellett, Natalie J Hannan, Fiona Brownfoot, Tu'uhevaha J Kaitu'u-Lino, Stephen Tong
Ectopic pregnancies complicate 1-2 pregnancies and are a leading cause of maternal death. An effective oral drug therapy that replaces surgery might make its treatment safer, cheaper, simpler and therefore more widely accessible. The only current medical treatment offered to women is intramuscular methotrexate, but this only reliably resolves smaller ectopic pregnancies. As such, many ectopic pregnancies require surgical excision. We show that vinorelbine, an orally available chemotherapeutic agent, potently induced placental cell death but did not harm fertility in mice...
February 2, 2018: EBioMedicine
Young Ran Kim, Myoung Jin Moon
Objective: To assess the efficacy and safety of ultrasound-guided intragestational injection of methotrexate (MTX) and systemic intramuscular MTX in the management of cesarean scar pregnancies. Methods: This was a retrospective case-control study that included women diagnosed with cesarean scar pregnancy at CHA Bundang Medical Center unit between 2009 and 2015. The 26 cases were managed with local injection of MTX under ultrasound guidance and 15 cases were treated with systemic intramuscular of MTX...
January 2018: Obstetrics & Gynecology Science
Judy Slome Cohain, Rina E Buxbaum, David Mankuta
BACKGROUND: The purpose of this study was to quantify spontaneous first trimester miscarriage rates per woman among parous women. A vast amount of data has accumulated regarding miscarriage rates per recognized pregnancy as well as about recurrent miscarriage. This is the second study of miscarriage rates per woman in a parous population and the first study of recurrent and non-recurrent, spontaneous first trimester miscarriage rates per woman in a large parous population. METHODS: Extraction of the following variables from all delivery room admissions from both Hadassah Medical Centers in Jerusalem Israel, 2004-2014: # of first trimester spontaneous miscarriages, # live births; # living children; age on admission, pre-pregnancy height and weight, any smoking this pregnancy, any alcohol or drug abuse this pregnancy, blood type, history of ectopic pregnancy, history of cesarean surgery (CS) and use of any fertility treatment(s)...
December 22, 2017: BMC Pregnancy and Childbirth
Gabriel Levin, Henry H Chill, Amihai Rottenstreich
OBJECTIVE: Ectopic pregnancy is a common condition in the field of gynaecology, often treated with methotrexate. Adverse effects are common and usually mild. Severe adverse events are rare amongst patients treated with MTX for this condition. CASE: A 26-year-old healthy woman was admitted and treated medically with MTX for an ectopic pregnancy. The patient was treated in the standard drug labelled protocol with an intramuscular injection of 78 mg of MTX according to body surface area...
December 20, 2017: European Journal of Contraception & Reproductive Health Care
Eser Sefik Ozyurek, Evren Akmut, Erdal Kaya, Aysu Akca, Ozgur Akbayır
OBJECTIVES: This study identified patients who would benefit from an earlier additional medical intervention and/or continuing close surveillance even if commonly used parameters indicated sufficient medical treatment to determine markers of treatment failure. MATERIALS AND METHODS: A retrospective analysis of patients with a preliminary diagnosis of ectopic pregnancy treated with the single-dose methotrexate protocol. Group 1: cases cured with a single dose of methotrexate; Group 2: cases who required more than one dose of methotrexate or surgery following the first dose...
December 2017: Taiwanese Journal of Obstetrics & Gynecology
N Begum, S A Anwary, M Alfazzaman, Z Mahzabin, F Deeba, M A Mostafa, M Akhter, M M Rahman
This prospective observational study was carried out in the Infertility Unit, Department of Obstetrics and Gynaecology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, from February 2011 to December 2013. Sixty-nine (69) subfertile women who were seropositive for Chlamydia Trachomatis were included in this study. Inclusion criteria was patients with sub-fertility having age between 22 and 40 years, seeking infertility treatment, normal ovarian function, all normozoospermic male partner, duration of infertility ranged from 1...
October 2017: Mymensingh Medical Journal: MMJ
Elizabeth G Raymond, Yi-Ling Tan, Rodica Comendant, Irina Sagaidac, Stelian Hodorogea, Melissa Grant, Patricio Sanhueza, Emigdio Van Pratt, Ginger Gillespie, Christy Boraas, Mark A Weaver, Ingrida Platais, Manuel Bousieguez, Beverly Winikoff
OBJECTIVES: The objectives were to evaluate the safety and acceptability of outpatient medical abortion in selected women without a pretreatment ultrasound or pelvic examination. STUDY DESIGN: We conducted a prospective case-series study to estimate the incidence of serious adverse events (death, life-threatening event, hospitalization, transfusion or any other medical problem that we judged to be significant), surgical completion of the abortion and satisfaction in women provided with medical abortion without a pretreatment ultrasound or pelvic examination...
November 21, 2017: Contraception
Christoph Hübener, Martin Bidlingmaier, Zida Wu, Joachim Diebold, Christian J Strasburger, Sven Mahner, Uwe Hasbargen, Maria Delius
OBJECTIVE: To investigate human placental growth hormone (hGH-V) in ectopic pregnancy (EP): detection in maternal blood, correlation with immunohistochemistry and possible role as a marker for the course of EP. DESIGN: Women presenting in the outpatient or emergency department of a tertiary care university hospital with a positive pregnancy test and strong suspicion of EP by ultrasound and/or symptoms were eligible for the study (n=70). Tissue specimens from the surgically treated patients (n=50) were examined by histopathology as well as by a hGH-V specific immohistochemistry set-up...
December 2017: Growth Hormone & IGF Research
Hatice Akkaya, Gulsum Uysal
OBJECTIVE: Ectopic pregnancy (EP) is the major cause of maternal morbidity and mortalityinthe first trimester of pregnancy. EP can be treated either medical or surgical approches. The purpose of our study wasto predict the treatment choice of tubal EP by usinghematologic parameters which are routinely used in clinical practice. METHODS: After retrospectively data evaluation was done from Januaryu 2014 to Deceber 201. we had 153 patients with EP. Patientsadmitted to methotrexate (MTX) therapy was Group-1...
July 2017: Pakistan Journal of Medical Sciences Quarterly
Robert Lee, Carolyn Dupuis, Byron Chen, Andrew Smith, Young H Kim
Ectopic pregnancy is the implantation of a fertilized egg outside the uterine endometrial cavity. For women presenting to the emergency department with abdominal pain and/or vaginal bleeding, ectopic pregnancy is an important diagnostic consideration. The diagnosis is made based on laboratory values and ultrasound imaging findings. The ultrasound appearance of both normal early pregnancy and ectopic pregnancy are variable and often subtle, presenting diagnostic challenges for radiologists. This pictorial essay describes and illustrates the sonographic findings of ectopic pregnancy and reviews the differential diagnoses that can mimic ectopic pregnancy on ultrasound...
August 19, 2017: Ultrasonography
Paula C Brady
Importance: Ectopic pregnancy is a leading source of morbidity and mortality in pregnancy, accounting for 1% to 2% of all pregnancies. Timely diagnosis and management of these abnormal gestations are vital to patient safety. Objective: The objective of this study was to describe recent evidence in the risk factors, diagnosis, and management of ectopic pregnancy. Evidence Acquisition: Comprehensive review of the published literature. Results: Recent literature describes newly identified risk factors for ectopic pregnancy, particularly those specific to assisted reproduction...
October 2017: Obstetrical & Gynecological Survey
Lifeng Chen, Danpeng Zhu, Qing Wu, Yan Yu
OBJECTIVE: This study presents our experience with laparoscopic surgery for tubal ectopic pregnancy (EP), sums up the different features of two commonly utilized laparoscopic surgeries, and compares subsequent post-salpingectomy or -salpingotomy reproductive outcomes in women with tubal EPs. STUDY DESIGN: Medical history data of 95 patients diagnosed with tubal EP between January 2013 and December 2014 were analyzed in a retrospective, observational manner. All patients studied were offered two surgical management options: salpingectomy (removal of the entire fallopian tube), or salpingotomy (removal of products of gestation only, leaving the remainder of the tube intact)...
December 2017: International Journal of Surgery
Sunullah Soysal, Gökçe Anık İlhan, Mehmet Vural, Begüm Yıldızhan
Severe methotrexate toxicity due to medical treatment of an ectopic pregnancy is presented. The feasibility of low-dose use and success of methotrexate makes it the first drug in the medical treatment of ectopic pregnancies. Besides its advantages, it should be used with caution and severe toxicity should be kept in mind.
December 2016: Turkish Journal of Obstetrics and Gynecology
Serpil Aydoğmuş, Hüseyin Aydoğmuş, Servet Gençdal, Sefa Kelekçi
OBJECTIVES: The diagnosis of ectopic pregnancy has been facilitated especially by the use of Doppler ultrasonography. In previous studies the presence of peri-trophoblastic blood flow by Doppler ultrasound and the detection of a low-resistance, high-velocity flow pattern were defined as specific signs for trophoblastic tissue. The aim of this study was to evaluate the efficacy of Doppler ultrasonography in the prediction of treatment success in tubal pregnancies being treated with single dose conservative methotrexate...
October 2017: European Journal of Obstetrics, Gynecology, and Reproductive Biology
Grace Younes, Togas Tulandi
OBJECTIVE: To systematically review and summarize the existing evidence related to the effect of adenomyosis on fertility and on in vitro fertilization (IVF) clinical outcomes, and to explore the effects of surgical or medical treatments. DESIGN: Meta-analysis. SETTING: Not applicable. PATIENT(S): An electronic-based search was performed with the use of the following databases: Pubmed, Embase, Ovid Medline, Cochrane Central Register of Controlled Trials, and Google Scholar, identifying all related articles up to November 2016...
September 2017: Fertility and Sterility
I Bizjak, C Fiala, L Berggren, H Hognert, I Sääv, J Bring, K Gemzell-Danielsson
OBJECTIVE: To assess the efficacy and safety of medical termination of pregnancy (MTOP) when no intrauterine pregnancy (IUP) is confirmed on ultrasound. DESIGN: Retrospective case-note review. SETTING: Two gynaecological clinics in Vienna, Austria, and Gothenburg, Sweden. POPULATION: All women with gestations of ≤49 days undergoing an MTOP during 2004-14 (Vienna) and 2012-15 (Gothenburg). METHODS: Two study cohorts were created: women with and women without a confirmed IUP...
August 30, 2017: BJOG: An International Journal of Obstetrics and Gynaecology
Ran Svirsky, Ido Ben-Ami, Matitiahu Berkovitch, Reuvit Halperin, Uri Rozovski
OBJECTIVE: To assess the risk of adverse pregnancy outcomes in subsequent pregnancies among women treated with methotrexate for ectopic pregnancy. METHODS: In a retrospective single-center study, data were assessed for women treated with methotrexate for ectopic pregnancy at Asaf Harofe Medical Center, Zerifin, Israel, between May 2004 and May 2014. RESULTS: Overall, 226 women were treated with methotrexate for ectopic pregnancy and subsequently conceived...
November 2017: International Journal of Gynaecology and Obstetrics
Bárbara Araujo, Sandra Belo, Davide Carvalho
Context Management of prolactinomas during pregnancy has always been a challenge. There is a concern about the risk of tumor growth, as well as the effects of the treatment on the developing fetus. Another issue that has been less studied is the outcome of women with prolactinoma after pregnancy and lactation. Objectives To evaluate remission of hyperprolactinaemia after pregnancy and lactation in women with prolactinoma. To describe the safety of dopamine agonists for the fetus and pregnancy outcomes. Methods A retrospective study of 32 pregnancies in women with prolactinoma was conducted in a single-centre...
November 2017: Experimental and Clinical Endocrinology & Diabetes
Aderemi Olaoluwa Alalade, Fredrick John Ennis Smith, Charlotte Emma Kendall, Funlayo Odejinmi
Recent advances in ultrasonography and the use of other modalities including magnetic resonance imaging scans have led to the early and more accurate diagnosis of non-tubal ectopic pregnancies (NTE). As a result, the management of these pregnancies has evolved. This article addresses the management options currently available for NTE. While surgical management remains the mainstay of treatment for ovarian, abdominal and cornual ectopics, there is growing evidence that some of these can be managed medically...
November 2017: Journal of Obstetrics and Gynaecology: the Journal of the Institute of Obstetrics and Gynaecology
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