DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20160899

Can we widen the scope of medical management in ectopic pregnancy?

Usha Kiran TS, Rajashree Dayanand Katke, Priyadarshani Mane

Abstract


The objective of the study was to Safe Medical management of ectopic pregnancy in those where surgical management was indicated. Patients with one or more criteria not suitable for medical treatment but refusing surgical management were included. Exclusion criteria were those who were not haemodynamically stable. They were managed with close monitoring as inpatient to assess resolution of ectopic with Methotrexate. All five cases have been managed successfully by medical method. There is a possible role for medical management in patients who might not satisfy the criteria fully, however further research is needed. Ectopic pregnancy is life threatening disorder. With advances in diagnostic approaches such as ultrasound coupled with hormone markers diagnosis of ectopic has become easier in cases having first trimester bleeding per vaginum. Ectopic can be managed expectantly, medically and surgically. Medical management includes Inj. Methotrexate (MTX). In this case series we have studied five cases which are managed successfully with hundred percent successful results by medical management despite not satisfying criteria. It is a retrospective study. So from this study we can conclude that we can manage ectopic pregnancies medically based upon clinical judgment.


Keywords


Ectopic pregnancy, Methotrexate

Full Text:

PDF

References


Walker JJ. Ectopic pregnancy. Clin Obstet Gynecol. 2007;50:89-99.

Della-Giustina D, Denny M. Ectopic pregnancy. Emerg Med Clin North Am. 2003;21:565-84.

Varma R, Gupta J. Tubal ectopic pregnancy. Clin Evid. 2009;2009:1406.

Horne AW, Duncan WC, Critchley HO. The need for serum biomarker development for diagnosing and excluding tubal ectopic pregnancy. Acta Obstet Gynecol Scand. 2010;89:299-301.

Goldner TE, Lawson HW, Xia Z, et al. Surveillance for ectopic pregnancy - United States, 1970-1989. MMWR CDC Surveill Summ. 1993;42:73-85.

Chang J, Elam-Evans LD, Berg CJ, et al. Pregnancy-related mortality surveillance - United States, 1991-1999. MMWR Surveill Summ. 2003;52:1-8.

Copyright Molson medical informatics project at McGill University, 2000.

Condous G, Timmerman D, Goldstein S, et al. Pregnancies of unknown location: consensus statement. Ultrasound Obstet Gynecol. 2006;28:121-2.

Lipscomb GH, McCord ML, Stovall TG. Predictors of success of methotrexate treatment in women with tubal ectopic pregnancies. N Engl J Med. 1999;341:1974-8.

Lipscomb GH, Bran D, McCord ML. Analysis of three hundred fifteen ectopic pregnancies treated with single-dose methotrexate. Am J Obstet Gynecol. 1998;178:1354-8.

Sowter MC, Farquhar CM, Petrie KJ, et al. A randomised trial comparing single dose systemic methotrexate and laparoscopic surgery for the treatment of unruptured tubal pregnancy. BJOG. 2001;108:192-203.