Medical management of ectopic pregnancy in a low resource setting: the role of methotrexate

Authors

  • Simon Birame Ndour Department of Medicine, Cheikh Anta DIOP University, Dakar, Senegal
  • Mamour Gueye Department of Medicine, Cheikh Anta DIOP University, Dakar, Senegal
  • Abdoul Aziz Diouf Department of Medicine, Cheikh Anta DIOP University, Dakar, Senegal
  • Moussa Diallo Department of Medicine, Cheikh Anta DIOP University, Dakar, Senegal

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20210703

Keywords:

Dakar (Senegal), Ectopic pregnancy, Low resource, Methotrexate

Abstract

Background: Medical treatment using methotrexate. However, its indications and the protocol of administration are still under discussion. Even if follow-up problems are often raised in developing countries, medical treatment of ectopic pregnancy remains a reasonable option that we practice and share our experience here.

Methods: We performed a retrospective cohort study of patients managed for an unruptured ectopic pregnancy in two university hospital facilities in Dakar: the Centre Hospitalier National de Pikine and the Centre de Santé de Philipe Maguilen Senghor. The data of this study are spread over a period of 10 years, from 2010 and 2019. We planned to evaluate maternal age, parity, gestational age, diagnosis circumstances, medical management, monitoring, and outcome. A single dose protocol was used. Data extracted from the registries were transferred to Microsoft Excel 2019, Mac version and then moved to SPSS (Statistical Package for Social Sciences, 26.

Results: Over ten years, we had registered 18 patients who had received medical treatment out of a total of 263 ectopic pregnancies treated in the two facilities, i.e., a frequency of 6.8%. The average age was 28.8 years. The average initial HCG level was 10,460 mIU/ml. Treatment succeeded in more than 6 out of 10 patients (61.1%). However, we noted 5 cases of failure that had secondarily benefited from salpingectomy by laparotomy.

Conclusions: Methotrexate is now part of the therapeutic arsenal in the management of unruptured tubal ectopic pregnancies. However, in developing countries, particularly in Senegal, there is a reluctance to use this therapeutic method, which, however, when a personalized follow-up is carried out, is achievable with a success rate comparable to other therapeutic methods.

References

Dupuis O, Camagna O, Benifla JL, Batallan A, Renolleau C, Madelenat P. Grossesse extra-utérine. 2001;5:30-2.

Xia Q, Wang T, Xian J, Song J, Qiao Y, Mu Z, et al. Relation of Chlamydia trachomatis infections to ectopic pregnancy: a meta-analysis and systematic review. Medicine Janv. 2020;99(1):e18489.

Bruhat MA, Manhes H, Mage G, Pouly JL. Treatment of ectopic pregnancy by means of laparoscopy. Fertil Steril. 1980;33(4):411‑4.

Dubuisson JB, Aubriot FX, Cardone V. Laparoscopic salpingectomy for tubal pregnancy. Fertil Steril. 1987;47(2):225‑8.

Agdi M, Tulandi T. Surgical treatment of ectopic pregnancy. Clin Obstet Gynaecol. 2009;23(4):519‑27.

Tanaka T, Hayashi H, Kutsuzawa T, Fujimoto S, Ichinoe K. Treatment of interstitial ectopic pregnancy with methotrexate: report of a successful case. Fertil Steril. 1982;37(6):851‑2.

Rongières C. Grossesse extra-utérine : pour le traitement. Conservateur Médical. 2007;4:87-9.

Altaras M, Cohen I, Cordoba M, Nun I, Aderet N. Treatment of an interstitial pregnancy with actinomycin D. Case report. 1988;95(12):1321‑3.

Marret H, Fauconnier A, Dubernard G, Misme H, Lagarce L, Lesavre M, et al. Evidence-based evaluation and expertise of methotrexate off label use in gynaecology and obstetrics: work of the CNGOF. J Gynecol Obstet Biol Reprod. 2015;44(3):230‑6.

Barnhart K, Coutifaris C, Esposito M. The pharmacology of methotrexate. Expert Opin Pharmacother. 2001;2(3):409‑17.

Brown DL, Felker RE, Stovall TG, Emerson DS, Ling FW. Serial endovaginal sonography of ectopic pregnancies treated with methotrexate. Obstet Gynecol. 1991;77(3):406‑9.

Hajenius PJ, Mol F, Mol BWJ, Bossuyt PMM, Ankum WM, Veen F. Interventions for tubal ectopic pregnancy. Cochrane Database Syst Rev. 2007;(1):CD000324.

Robertson DE, Smith W, Moye MA, Brinsden PR, Hansen JN, Lewis PM, et al. Reduction of ectopic pregnancy by injection under ultrasound control. Lancet Lond Engl. 1987;1(8539):974‑5.

Laatikainen T, Tuomivaara L, Käär K. Comparison of a local injection of hyperosmolar glucose solution with salpingostomy for the conservative treatment of tubal pregnancy. Fertil Steril. 1993;60(1):80‑4.

Lipscomb GH, Stovall TG, Ling FW. Nonsurgical treatment of ectopic pregnancy. N Engl J Med. 2000;343(18):1325‑9.

Stovall TG, Ling FW, Gray LA. Single-dose methotrexate for treatment of ectopic pregnancy. Obstet Gynecol. 1991;77(5):754‑7.

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.

Barnhart K, Hummel AC, Sammel MD, Menon S, Jain J, Chakhtoura N. Use of 2-dose regimen of methotrexate to treat ectopic pregnancy. Fertil Steril. 2007;87(2):250‑6.

Gervaise A, Fernandez H. Prise en charge diagnostique et thérapeutique des grossesses extra-utérines. J Gynécologie Obstétrique Biol Reprod. 2010;3:17-24.

Lesavre M, Curinier S, Capmas P, Rabischong B, Fernandez H. Utilisation du méthotrexate dans les GEU tubaires. J Gynécologie Obstétrique Biol Reprod. 2008;44:212-19.

Lipscomb GH, Bran D, McCord ML, Portera JC, Ling FW. Analysis of three hundred fifteen ectopic pregnancies treated with single-dose methotrexate. Am J Obstet Gynecol. 1998;178(6):1354‑8.

Gassama O, Dieme MF, Diallo M, Niang MM. Traitement médical d’une grossesse extra-utérine tubaire avec embryon : à propos d’un cas au Centre de Santé Nabil Choucair(Dakar ,Sénégal)T. J Sago. 2015;16(2):45-9.

Practice Committee of the American Society for Reproductive Medicine. Medical treatment of ectopic pregnancy. Fertil Steril. 2006;86(51):96-102.

Moeller LB, Moeller C, Thomsen SG, Andersen LF, Lundvall L, Lidegaard Ø, et al. Success and spontaneous pregnancy rates following systemic methotrexate versus laparoscopic surgery for tubal pregnancies: a randomized trial. Acta Obstet Gynecol Scand. 2009;88(12):1331‑7.

Mol F, Mol BW, Ankum WM, Veen F, Hajenius PJ. Current evidence on surgery, systemic methotrexate and expectant management in the treatment of tubal ectopic pregnancy: a systematic review and meta-analysis. Hum Reprod. 2008;14(4):309‑19.

Mol BW, Hajenius PJ, Engelsbel S, Ankum WM, Hemrika DJ, Veen F, et al. Treatment of tubal pregnancy in the netherlands: an economic comparison of systemic methotrexate administration and laparoscopic salpingostomy. Am J Obstet Gynecol. 1999;181(4):945‑51.

Sowter MC, Farquhar CM. Ectopic pregnancy: an update. Curr Opin Obstet Gynecol. 2004;16(4):289‑93.

Nieuwkerk PT, Hajenius PJ, Ankum WM, Veen F, Wijker W, Bossuyt PM. Systemic methotrexate therapy versus laparoscopic salpingostomy in patients with tubal pregnancy. Part I. Impact on patients’ health-related quality of life. Fertil Steril. 1998;70(3):511‑7.

Downloads

Published

2021-02-24

Issue

Section

Original Research Articles