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Medical Treatment Ectopic Pregnancy

D Jurkovic, M Memtsa, E Sawyer, Ana Donaldson, A Jamil, K Schramm, Y Sana, M Otify, L Farahani, N Nunes, G Ambler, J A Ross
OBJECTIVE: Methotrexate is routinely used worldwide for medical treatment of clinically stable women with tubal ectopic pregnancies. This is despite the lack of robust evidence to show its superior effectiveness over expectant management. The aim of our multicentre randomised trial study was to compare the success rates of methotrexate with placebo for the conservative treatment of tubal ectopic pregnancies. METHODS: The study was multicentre; it took place in three UK early pregnancy units between January 2006 and June 2014...
October 12, 2016: Ultrasound in Obstetrics & Gynecology
N Navali, A Gassemzadeh, L Farzadi, S Abdollahi, M Nouri, K Hamdi, F Mallah, F Jalilvand
STUDY QUESTION: Does the intrauterine administration of hCG immediately after oocyte retrieval in antagonist cycles with ICSI and fresh embryo transfer (ET) influence the implantation rate or chemical and clinical pregnancy rates? SUMMARY ANSWER: The intrauterine administration of hCG after oocyte retrieval increases the implantation rate and chemical and clinical pregnancy rates. WHAT IS KNOWN ALREADY: Over half of IVF/ICSI cycles fail due to implantation failure...
September 28, 2016: Human Reproduction
Tamer Hanafy Said
BACKGROUND AND OBJECTIVE: To determine the safety and sustainability of operative laparoscopy in surgical management of cornual and interstitial ectopic pregnancy using a simple and practical method. DESIGN: Case series of five consecutive cases. SETTING: Endoscopy unit in Alexandria University Hospital and Alexandria New Medical Center. PATIENTS: Between July 2013 and May 2015, five women with interstitial and cornual ectopic pregnancies were admitted for laparoscopic surgical treatment...
October 2016: Journal of Obstetrics and Gynaecology of India
Aysen Boza, Barıs Boza, Murat Api
Cesarean scar pregnancy (CSP) is a rare, but life-threatening type of ectopic pregnancy. An exact and early diagnosis of CSP is very important for prognosis. The aim of the present study was to describe 4 women with CSP and discuss their clinical presentations, diagnoses, and various management options along with the published literature. Four women with a suspicion of CSP or cervical pregnancy were referred to our hospital between August 2013 and January 2014. All the patients were counseled about medical management options...
September 2016: Iranian Journal of Medical Sciences
Breanne B Das, Jocelyn Ronda, Maria Trent
PURPOSE: Pelvic inflammatory disease (PID) is a common disorder of the reproductive tract that is frequently misdiagnosed and inadequately treated. PID and its complications, such as infertility, ectopic pregnancy, and chronic pelvic pain, are preventable by screening asymptomatic patients for sexually transmitted infections (STIs) and promptly treating individuals with STIs and PID. RECENT FINDINGS: The rates of adverse outcomes in women with PID are high and disproportionately affect young minority women...
2016: Infection and Drug Resistance
Henri Marret, Arnaud Fauconnier, Gil Dubernard, Hélène Misme, Laurence Lagarce, Magali Lesavre, Hervé Fernandez, Camille Mimoun, Claire Tourette, Sandra Curinier, Benoit Rabishong, Aubert Agostini
Our objective is to describe off-label use of methotrexate in ectopic pregnancy treatment using evidence based medicine. The patient group includes all women with a pregnancy outside the usual endometrium, or of unknown location. Method used was a Medline search on ectopic pregnancy managed using methotrexate treatment; evidence synthesis was done based on this current literature analysis. Level of evidence (LE) were given according to the centre for evidence base medicine rules. Grade was proposed for guidelines but no recommendation was possible as misoprostol is off label use for all the indications studied...
October 2016: European Journal of Obstetrics, Gynecology, and Reproductive Biology
Monica Hagan Vetter, Joseph Andrzejewski, Alan Murnane, Christopher Lang
BACKGROUND: Spontaneously conceived heterotopic pregnancies are rare. A heterotopic cesarean scar pregnancy involves an intrauterine pregnancy and a second pregnancy in the cesarean scar. Treatment approaches include both medical and surgical management. We present a surgical approach to the treatment of a heterotopic cesarean scar pregnancy with preservation of an intrauterine gestation. CASE: A 29-year-old woman, gravida 4 para 1021, presented at 5 weeks of gestation with spotting...
September 2016: Obstetrics and Gynecology
J Racková, D Driák, H Neumannová, K Hurt, B Sehnal, M Halaška
OBJECTIVE: There are only a few gynaecological departments in the Czech Republic that use medical treatment of the ectopic pregnancy (EP) or persistent pregnancy of unknown location (PUL). We have started using this method in 2008 at our clinic. The aim of this study was to assess the success rate of conservative medical treatment with methotrexate (MTX) in the dose of 1 mg/kg intramuscularly in patients with ectopic pregnancy or persistent pregnancy of unknown location and to compare the results of clinical history, clinical finding and laboratory results in a group of successful and a group of unsuccessful treatment...
April 2016: Ceská Gynekologie
Askin Dogan, Ibrahim Gulhan, Ibrahim Uyar, Atalay Ekin, Cenk Gezer, Muzaffer Bilgin, Cüneyt E Taner, Ibrahim E Ertas
Our aim was to evaluate the relationship between the success of methotrexate treatment and β-hCG levels in progressive tubal ectopic pregnancies. We defined a retrospective cohort of 394 progressive tubal ectopic pregnancy patients treated with methotrexate. A single-dose methotrexate protocol using 50 mg/m(2) was administered to patients with progressive tubal ectopic pregnancy. Surgery was performed in patients who exhibited signs of acute abdomen due to tubal rupture. Of 394 patients that received methotrexate treatment, 335 (84...
June 2016: Kaohsiung Journal of Medical Sciences
Michelle C Mergenthal, Suneeta Senapati, Jarcy Zee, Lynne Allen-Taylor, Paul G Whittaker, Peter Takacs, Mary D Sammel, Kurt T Barnhart
BACKGROUND: Ectopic pregnancy, though rare, is an important cause of female morbidity and mortality and early, effective treatment is critical. Systemic methotrexate has become widely accepted as a safe and effective alternative to surgery in the stable patient. As the number and timing of methotrexate doses differ in the three main medical treatment regimens, one might expect trends in serum human Chorionic Gonadotropin and time to resolution to vary depending on protocol. Furthermore, human Chorionic Gonadotropin trends and time to resolution may predict ultimate treatment success...
June 28, 2016: American Journal of Obstetrics and Gynecology
Marco Antonio Avila-Vergara, Alma Rita Peña-Ayón, Luis Enrique Guzmán-Gutiérrez, Jesús Everardo Valenzuela-Verduzco, Carmen Beatriz Caballero-Rodríguez, Felipe Vadillo-Ortega
BACKGROUND: Ovarian pregnancy (OP) is a low-frequency pathology but with devastating effects on women reproductive health. It is often difficult to distinguish from tubal or abdominal pregnancy. Diagnostic procedures and actual medical approaches to the treatment of OP are still a challenge. CLINICAL CASE: In this paper we present a 21 years old woman, seen at the Hospital as emergency abdominal pain and hypovolemic shock, with a pregnancy of 14 weeks of gestational age...
November 2015: Ginecología y Obstetricia de México
Sophia Yen, Monika K Goyal, Paula Hillard
Adolescent females frequently present to the ED with complaints that may be caused by a gynecologic emergency. Differentiating and excluding some of the common and most serious gynecologic emergencies reviewed in this article are critical. Timely and effective treatment of these conditions, once diagnosed, can result in better health outcomes.
December 2015: Adolescent Medicine: State of the Art Reviews
A Ohannessian, P Crochet, B Courbiere, A Gnisci, A Agostini
OBJECTIVES: Ectopic pregnancy (EP) occurs in 2% to 5.6% of pregnancies achieved by assisted reproductive technology (ART). EP treatment options include medical treatment by uses of methotrexate (MTX) systemic injection. The objective of this study was to compare MTX treatment effectiveness for EP occurring spontaneously or following ART. METHODS: A case-control study performed in the department of obstetrics and gynecology at a tertiary health care center in France...
May 20, 2016: Gynécologie, Obstétrique & Fertilité
Laurence Lagarce, Nathalie Bernard, Patrick Carlier, Silviana Phelipot-Lates, Marie-Christine Perault-Pochat, Guillaume Drablier, Delphine Bourneau-Martin, Pascale Lainé-Cessac
INTRODUCTION: Methotrexate (MTX) is a known teratogenic drug used off-label in the treatment of ectopic pregnancies (EP). As MTX polyglutamated derivatives remains into the cells during several weeks, it is recommended to avoid conception during 3 to 6 months following MTX therapy. We report the follow-up of pregnancies after preconceptional exposure to MTX for EP. MATERIAL/METHODS: Prospective cases of pregnancy occurring within 3 months after MTX injection for an EP recorded in the Terappel database were analyzed...
September 2016: Thérapie
E Abalos, V Addo, P Brocklehurst, M El Sheikh, B Farrell, S Gray, P Hardy, E Juszczak, J E Mathews, S Naz Masood, E Oyarzun, J Oyieke, J B Sharma, P Spark
BACKGROUND: The CORONIS trial reported differences in short-term maternal morbidity when comparing five pairs of alternative surgical techniques for caesarean section. Here we report outcomes at 3 years follow-up. METHODS: The CORONIS trial was a pragmatic international 2 × 2 × 2 × 2× 2 non-regular fractional, factorial, unmasked, randomised controlled trial done at 19 sites in Argentina, Chile, Ghana, India, Kenya, Pakistan, and Sudan. Pregnant women were eligible if they were to undergo their first or second caesarean section through a planned transverse abdominal incision...
July 2, 2016: Lancet
Paolo Emanuele Levi Setti, Melita Moioli, Antonella Smeraldi, Elisa Cesaratto, Francesca Menduni, Stefania Livio, Emanuela Morenghi, Pasquale Patrizio
PURPOSE: The aim of this study was to provide a comprehensive follow-up of fetal and perinatal outcome and the incidence of congenital anomalies in babies born after fresh embryo transfers compared to those conceived spontaneously in infertile couples. METHODS: Retrospective comparative analysis of all clinical pregnancies from fresh cleavage-stage embryo transfer cycles (IVF and ICSI) compared with infertile patients who conceived spontaneously in the same time period (control)...
June 2016: Journal of Assisted Reproduction and Genetics
Richard J Persadie, Dustin Costescu-Green, Katherine M Gerster
BACKGROUND: Cervical ectopic pregnancy is an uncommon form of ectopic pregnancy. The spectrum of treatment options includes systemic medical therapy, local injection with methotrexate and/or potassium chloride, surgery, or a combination of these modalities. CASE: A 29-year-old woman, gravida 3, aborta 2, was found to have a cervical ectopic pregnancy on ultrasound at 5+6 weeks' gestation. She presented to the hospital with vaginal bleeding. Treatment was initiated with multidose methotrexate and leucovorin rescue...
March 2016: Journal of Obstetrics and Gynaecology Canada: JOGC, Journal D'obstétrique et Gynécologie du Canada: JOGC
Victoria Louise Parker, M Srinivas
PURPOSE: 11 per 1000 pregnancies are ectopic (NICE Guidelines, 2012) with 95 % of ectopic pregnancies being tubal in origin, and 80 % of these occurring within the ampulla (The Ectopic Pregnancy Trust). 5% therefore are non-tubal. In this review we aim to collate literature relevant to non-tubal ectopic pregnancy. METHODS: Literature regarding cornual, ovarian, abdominal, interstitial, cervical and Caesarean scar ectopic pregnancy was reviewed using EMBASE and Medline databases...
July 2016: Archives of Gynecology and Obstetrics
Ö Birge, C Karaca, D Arslan, E Kinali
AIM: Cesarean scar pregnancy is a rare condition that is increasing in frequency parallel to the increase in cesarean section rates. The authors hereby discuss a case with cesarean scar pregnancy at advanced age that was treated with methotrexate (MTX) in Nyala Sudan Turkey Training and Research Hospital. CONCLUSION: Cesarean scar pregnancy is a rare type of ectopic pregnancy that is increasing in number due to the increase in cesarean deliveries. Clinical vigilance is imperative for diagnosis and treatment of this highly mortal and morbid entity...
2016: Clinical and Experimental Obstetrics & Gynecology
Malcolm J Price, A E Ades, Kate Soldan, Nicky J Welton, John Macleod, Ian Simms, Daniela DeAngelis, Katherine Me Turner, Paddy J Horner
BACKGROUND AND OBJECTIVES: The evidence base supporting the National Chlamydia Screening Programme, initiated in 2003, has been questioned repeatedly, with little consensus on modelling assumptions, parameter values or evidence sources to be used in cost-effectiveness analyses. The purpose of this project was to assemble all available evidence on the prevalence and incidence of Chlamydia trachomatis (CT) in the UK and its sequelae, pelvic inflammatory disease (PID), ectopic pregnancy (EP) and tubal factor infertility (TFI) to review the evidence base in its entirety, assess its consistency and, if possible, arrive at a coherent set of estimates consistent with all the evidence...
March 2016: Health Technology Assessment: HTA
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