DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20202069

Comparison of outcome in medical versus expectant management in unruptured tubal pregnancy with β-hCG 1000-3000 IU/L

Sidra Arshad, Sonia Andeel, Samia Asghar, Sana Hafeez, Sana Asghar, Naheed Fatima

Abstract


Background: Ectopic pregnancy (EP) is an important cause of maternal morbidity as well as mortality in the 1st trimester. This study was done to compare outcome in medical versus expectant management in patients with unruptured tubal pregnancy having β-hCG 1000-3000 IU/L.

Methods: In this randomized controlled trial, 82 (41 in each group) women with tubal ectopic pregnancy (TEP) having β-hCG levels between 1000-3000 IU/L and 18 to 40 years of age were enrolled. Women having non-tubal pregnancy, ruptured ectopic pregnancy, heterotopic pregnancy, hypersensitivity to methotrexate were excluded. Included women were randomly assigned to either Group-A (expectant management) or Group-B (medical management). Outcome was measured after one week and considered successful if patient had β-hCG levels negligible i.e. <10 IU/L and complete resolution on ultrasonography (absence of adnexal mass, pelvic free fluid, gestational sac).

Results: Overall mean age was 30.65±6.37 years. The mean gestational age in Group-A was 7.12±2.12 weeks and 7.63±2.41 weeks in Group-B. The mean β-hCG levels in Group-A was 1984.63±515.81 IU/L and 1937.33±519.68 IU/L in Group-B. Outcome was successful in 90.24% in Group-A and 63.41% in Group-B (p-value=0.004).

Conclusions: Expectant management is associated with better outcome as compared to medical management in tubal ectopic pregnancy having β-hCG between 1000-3000 IU/L.


Keywords


Ectopic pregnancy, Expectant, Methotrexate, Resolution

Full Text:

PDF

References


Ali SK, Ali AA, Soomar SM. Diagnosis and management of ectopic pregnancy-a basic view through literature. Crit Care Obst Gyne. 2019;5(2):7.

Meena N, Bairwa R, Sharma S. Study of ectopic pregnancy in a tertiary care centre. Int J Reprod Contracept Obstet Gynecol. 2020;9(1):212-5.

Jurkvic D. Diagnosis and management of ectopic pregnancy. British Med J. 2011;342:3397.

Shaikh NB, Shaikh S, Shaikh F. A clinical study of ectopic pregnancy. J Ayub Med Coll Abbottabad. 2014;26(2):178-81.

Hakim H, Yaich R, Halouani S, Jouou S, Arfaoui R, Rachdi R. Non-surgical management of ectopic pregnancies. J Gynecol Oncol. 2019;2(2):1013.

ACOG Practice Bulletin No. 193 Summary: Tubal Ectopic Pregnancy. Obstet Gynecol. 2018;131:613-5.

Barash JH, Buchanan EM, Hillson C. Diagnosis and management of ectopic pregnancy. Am Fam Physician. 2014;90:34-40.

Van Mello NM, Mol F, Opmeer BC, Ankum WM, Barnhart K, Coomarasamy A, et al. Diagnostic value of serum hCG on the outcome of pregnancy of unknown location: a systematic review and meta-analysis. Hum Reprod Update. 2012;18(6):603-17.

Bignardi T, Alhamdan D, Condous G. Is ultrasound the new gold standard for the diagnosis of ectopic pregnancy? Semin Ultrasound CT MR. 2008;29(2):114-20.

Trio D, Strobelt N, Picciolo C, Lapinski RH, Ghidini A. Prognostic factors for successful expectant management of ectopic pregnancy. Fertil Steril. 1995;63(3):469-72.

Dhar H, Hamdi I, Rathi B. Methotrexate treatment of ectopic pregnancy: experience at Nizwa Hospital with literature review. Oman Med J. 2011;26(2):94-8.

Mooij R, Mgalega GC, Mwampagatwa IH, van Dillen J, Stekelenburg J. A cohort of women with ectopic pregnancy: challenges in diagnosis and management in a rural hospital in a low-income country. BMC Preg Childbirth. 2018;18(1):159.

van Mello NM, Mol F, Ankum WM, Mol BW, van der Veen F, Hajenius PJ. Ectopic pregnancy: how the diagnostic and therapeutic management has changed. Obstet Gynecol Surv. 2013;68(2):110-2.

Lund J. Early ectopic pregnancy -comments on conservative treatment. J Obstet Gynecol Br Empire. 1955;62:70-6.

Elson J, Tailor A, Banerjee S, Salim R, Hillaby K, Jurkovic D. Expectant management of tubal ectopic pregnancy: prediction of successful outcome using decision tree analysis. Ultrasound Obstet Gynaecol. 2004;23:552-6.

Korhonen J, Stenman UH, Ylöstalo P. Serum human chorionic gonadotropin dynamics during spontaneous resolution of ectopic pregnancy. Fertil Steril. 1994;61:632-6.

Kirk E, Van Calster B, Condous G, Papageorghiou AT, Gevaert O, Van Huffel S, et al. Ectopic pregnancy: using the hCG ratio to select women for expectant or medical management. Acta Obstet Gynecol Scand. 2011;90:264-72.

Lipscomb GH. Medical therapy for ectopic pregnancy. Semin Reprod Med. 2007;25(2):93-8.

Mahboob U, Mazhar SB. Management of ectopic pregnancy: a two-year study. J Ayub Med Coll Abbottabad. 2006;18(4):34-37.

Mavrelos D, Nicks H, Jamil A, Hoo W, Jauniaux E, Jurkovic D. Efficacy and safety of a clinical protocol for expectant management of selected women diagnosed with a tubal ectopic pregnancy. Ultrasound Obstet Gynecol. 2013;42:102-7.

Cacciatore B, Korhonen J, Stenman UH, Ylostalo P. Transvaginal sonography and serum hCG in monitoring of presumed ectopic pregnancies selected for expectant management. Ultrasound Obstet Gynecol. 1995;5:297-300.

Atri M, Chow CM, Kintzen G, Gillett P, Aldis AA, Thibodeau M, Reinhold C, Bret PM. Expectant treatment of ectopic pregnancies: clinical and sonographic predictors. AJR Am J Roentgenol. 2001;176:123-7.

Hajenius P, Engelsbel S, Mol BWJ, Van der Veen F, Ankum W, Bossuyt PMM, et al. Randomised trial of systemic methotrexate versus laparoscopic salpingostomy in tubal pregnancy. Lancet. 1997;350:774-9.

Kumar V, Gupta J. Tubal ectopic pregnancy. BMJ Clin Evid. 2015;2015:1406.