DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20210531

Management outcomes of ectopic pregnancy depending on different treatment modalities: a cohort study

Shawqi H. Alawdi, Mayada Roumieh, Marwan Alhalabi

Abstract


Background: Ectopic pregnancy is the most common cause of maternal morbidity and mortality during the first trimester of pregnancy. The present study aimed to review and evaluate the management outcomes of ectopic pregnancy in Damascus University Maternity Hospital, Syria.

Methods: A retrospective cohort study was performed on women referring to Damascus University Hospital of Obstetrics and Gynecology (OBGYN) for ectopic pregnancy. Patients were assigned into groups by method of treatment: expectant management (Group 1), single-dose methotrexate regimen (Group 2), two-dose methotrexate regimen (Group 3), and surgical intervention (Group 4). Parameters assessed were risk factors for ectopic pregnancies, transvaginal ultrasonography findings, serum human chorionic gonadotropin (hCG) levels on Days 0, 4, 7, and types of surgical intervention in women that underwent any surgical intervention. A treatment modality was considered successful when hCG levels declined to less than 5 mIU/L without further administration of methotrexate dose or need for surgery.

Results: Seventy-seven women with ectopic pregnancy were admitted to the hospital during the study period. Groups 1, 2, 3, and 4 constituted 20.8%, 13.0%, 6.5% and 59.7% of the patients respectively. The most common encountered risk factors for ectopic pregnancy in the patients were history of previous intra-abdominal or pelvic surgery (57.1%) and history of miscarriage (41.6%). A statistically significant difference in the serum hCG concentrations measured on day 0, day 4, and day 7 were observed between the groups.

Conclusions: The success rate in ectopic pregnancy treatment was 56.25% for the expectant management, 70% for the single-dose methotrexate regimen, and 40% for two-dose methotrexate regimen.


Keywords


Tubal pregnancy, Ectopic pregnancy, Methotrexate, hCG

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References


Jurkovic D, Memtsa M, Sawyer E, Donaldson ANA, A Jamil A, Schramm K et al. Single-dose systemic methotrexate vs expectant management for treatment of tubal ectopic pregnancy: a placebo-controlled randomized trial. Ultrasound Obstet Gynecol. 2017;49:171-6.

American College of Obstetricians and Gynecologists. ACOG practice bulletin: tubal ectopic pregnancy. Obstet Gynecol. 2018;131(3):e91-103.

Farquhar CM. Ectopic pregnancy. Lancet. 2005;366:583-91.

Kathpalia BSK, Arora CD, Sandhu N, Sinha P. Ectopic pregnancy: Review of 80 cases. MJAFI. 2018;74:172-6.

Lipscomb GH, Givens VM, Meyer NL, Bran D. Comparison of multidose and single-dose methotrexate protocols for the treatment of ectopic pregnancy. Am J Obstet Gynecol. 2005;192:1844-7.

Inal ZO, Inal HA. Comparison of Four Methods of Treating Ectopic Pregnancy: A Retrospective Cohort Study. Geburtsh Frauenheilk. 2018;78:70-7.

Dogan A, Gulhan I, Uyar I, Ekin A, Gezer C, Bilgin M et al. Methotrexate treatment in progressive tubal ectopic pregnancies and hCG-related clinicosurgical implications. Kaohsiung J Med Sci. 2016;32:317-22.

Levin I, Tsafrir Z, Saʼar N, Lessing J, Avni A, Gamzu R et al. Watchful waiting” in ectopic pregnancies: a balance between reduced success rates and less methotrexate. Fertil Steril. 2011;95:1159-60.

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

Ustunyurt E, Duran M, Coskun E, Ustunyurt OB, Simsek H. Role of initial and day 4 human chorionic gonadotropin levels in predicting the outcome of single-dose methotrexate treatment in women with tubal ectopic pregnancy. Arch Gynecol Obstet. 2013;288:1149-52.

YıldırımA, Cırık DA, Altay M, Gelisen O. Early prediction for the requirement of second or third dose methotrexate in women with ectopic pregnancy, treated with single-dose regimen. Arch Gynecol Obstet. 2015;291:1327-32.

Agostini A, Blanc K, Ronda I, Romain F, Capelle M, Blanc B. Prognostic value of human chorionic gonadotropin changes after methotrexate injection for ectopic pregnancy. Fertil Steril. 2007;88:504-506.

Bottin P, Gnisci A, Crochet, Butzbach P, Cravello L, Gamerre M et al. Prognostic value of early hCG changes after methotrexate injection for ectopic pregnancy. Gynecol Obstet Fertil. 2014;42:3-7.

Sagiv R, Debby A, Feit H Bina Cohen-Sacher B, Ran Keidar R, Golan A. The optimal cutoff serum level of human chorionic gonadotropin for efficacy of methotrexate treatment in women with extrauterine pregnancy. Int J Gynaecol Obstet. 2012;116:101-4.

Gamzu R, Almog B, Levin Y, Jaffa A, Lessing JB, Baram A. Efficacy of methotrexate treatment in extrauterine pregnancies defined by stable or increasing human chorionic gonadotropin concentrations. Fertil Steril. 2002;77:761-5.

Nowak-Markwitz E, Michalak M, Olejnik M, Spaczynski M. Cutoff value of human chorionic gonadotropin in relation to the number of methotrexate cycles in the successful treatment of ectopic pregnancy. Fertil Steril. 2009;92:1203-7.

Guvendag Guven ES, Dilbaz S, Dilbaz B, Yildirim BA, Akdag D, Haberal A. Comparison of single and multiple dose methotrexate therapy for unruptured tubal ectopic pregnancy: a prospective randomized study. Acta Obstet Gynecol Scand. 2010;89:889-95.

Natale A, Busacca M, Candiani M, Gruft L, Izzo S, Felicetta I et al. Human chorionic gonadotropin patterns after a single dose of methotrexate for ectopic pregnancy. Eurn J Obstet Gynecol Reprod Biol. 2002;100:227-30.

Potter MB, Lepine LA, Jamieson DJ. Predictors of success with methotrexate ntreatment of tubal ectopic pregnancy at Grady Memorial Hospital. Am J Obstet Gynecol. 2003;188:1192-4.