Medical management of ectopic pregnancy

Authors

  • Tseten Zangmu Bhutia Department of Obstetrics and Gynecology, Ramkrishna Mission Seva Pratisthan, Kolkata, West Bengal, India
  • Zigmee Dorjee Tamang Department of Obstetrics and Gynecology, Sikkim Manipal Institute of Medical Sciences, Sikkim, India
  • Goutam Giri Department of Obstetrics and Gynecology, Ramkrishna Mission Seva Pratisthan, Kolkata, West Bengal, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20203861

Keywords:

Ectopic pregnancy, Methotrexate, β-hCG

Abstract

Background: Ectopic pregnancy is a commonest cause of maternal morbidity and mortality in the first trimester of pregnancy. Clinical presentation of ectopic pregnancy has changed from life threatening disease to a more benign condition for which nonsurgical treatment options are available with methotrexate administered systemically or locally. The study was done to evaluate the outcome of medical management of ectopic pregnancy with single regimen methotrexate.

Methods: A cohort study was conducted over 18 months on 60 unruptured ectopic pregnancies who were treated with methotrexate injection.

Results: Out of 60 unruptured ectopic pregnancies, 53 (88.3%) were successfully treated with methotrexate. Failure rate was 11.7% (7/60) patients who underwent laparotomy. Success of medical treatment was dependent on pretreatment β-hCG (≤4102.5 mIU/mL), period of gestation (≤5 weeks), size of gestational sac (≤3 cm) above which the failure rate increases. No correlation was seen between fall of β-hCG from day 4 to 7 and the success rate. Mean time to resolution of β-hCG seen was 4.3±1.25 weeks. Mean duration of hospital stay was 8.85±1.603 days. Single dose regimen of methotrexate was given to all patients and only 1/60 patients required second dose of methotrexate for suboptimal decrease of β-hCG.

Conclusions: The result showed that pretreatment β-hCG level and period of gestation were good predictors for success of medical treatment.

Author Biographies

Tseten Zangmu Bhutia, Department of Obstetrics and Gynecology, Ramkrishna Mission Seva Pratisthan, Kolkata, West Bengal, India

Senior Resident

Department of Obstetrics & Gynaecology

Ramkrishna Mission Seva Pratisthan

Zigmee Dorjee Tamang, Department of Obstetrics and Gynecology, Sikkim Manipal Institute of Medical Sciences, Sikkim, India

Assistant Professor

Department of Obsterics & Gynaecology.

SMIMS

Goutam Giri, Department of Obstetrics and Gynecology, Ramkrishna Mission Seva Pratisthan, Kolkata, West Bengal, India

Assistant Professor

Department of Obstetrics & Gynaecology

Ramkrishna Mission Seva Pratisthan

References

Mahboob U, Mazhar SB. Management of ectopic pregnancy: a two-year study. J Ayub Med Coll Abbotlabad. 2006;18(4):34-7.

Centers for disease control and prevention (CDC). Ectopic pregnancy: United States, 1990-1992. MMWR Morb Mortal Wkly Rep. 1995;44(3):46-8.

Bouyer J, Coste J, Fernandez H, Pouly JL, Job-Spira N. Sites of ectopic pregnancy: a 10 year population-based study of 1800 cases. Hum Reprod. 2002;17(12):3224-30.

Tay JI, Moore J, Walker JJ. Ectopic pregnancy. West J Med. 2000;17(2):131-4.

Berg CJ, Chang J, Collaghan WM, Whitehead SJ. Pregnancy related mortality in the United States, 1991-1997. Obstet Gynecol. 2003;101(2):289-96.

Barnhart KT, Gosman G, Ashby R, Sammel M. The medical management of ectopic pregnancy: a meta-analysis comparing single dose and multidose regimens. Obstet Gynecol. 2003;101(4):778-84.

Pisarska MD, Carson SA, Buster JE. Ectopic pregnancy. Lancet. 1998;351(9109):1115-20.

Vaswani PR. Predictors of success of medical management of ectopic pregnancy in a tertiary care hospital in United Arab Emirates. J Clin Diagn Res. 2001;8(8):4-8.

Menon S, Colins J, Barnhart KT. Establishing a human chorionic gonadotropin cut off to guide methotrexate treatment of ectopic pregnancy: a systemic review. Fertil Steril. 2007;87(3):481-4.

Lee Y, So C, Chan W, Lee K. Predictors of success of methotrexate in treatment of ectopic pregnancy: a new perspective. Hong Kong J Gynaecol Obstet Midwifery. 2016;16(1):73-8.

Shah SR, Sonara S, Patel B, Patel N. Medical management of ectopic pregnancy with methotrexate. Indian J Clin Pract. 2014;24(11):1048-52.

Krik E, Bottomley C, Bourne T. Diagnosing ectopic pregnancy and current concepts in the management of pregnancy of unknown location. Hum Reprod Update. 2014;20(2):250-61.

Downloads

Published

2020-08-27

Issue

Section

Original Research Articles