Assessment of Methotrexate Efficacy in The Treatment of Ectopic Pregnancy

Yıl 2019, Cilt: 7 Sayı: 1, 25 - 30, 22.04.2019

Mehmet Obut Hanifi Bademkıran Sedat Akgöl Bekir Kahveci İhsan Bağlı Süleyman Cemil Oğlak Mehmet Şukru Budak

Öz

ABSTRACT

Objective: Our aim in this study was to assess  efficacy of single-dose methotrexate (MTX) as
medical treatment for ectopic pregnancy (EP) by evaluating the results of patients
given this treatment.

Materials
and Methods: Between
September 2016 and August 2017, the treatment outcomes of EP cases treated with
MTX at Gazi Yaşargil Training and Research Hospital of Health Sciences
University were evaluated retrospectively.

Results:
In total, 126 cases treated for EP were
evaluated and 65 cases were included in the study. In cases administered a single
dose of MTX, the success rate was 80%, the failure rate was 13.8%, and the emergency
surgery rate was 6.2%. The overall success rate of the medical treatment was
90.7% for a second dose of MTX. An unsuccessful result was considered as less
than a 15% reduction in the beta-human chorionic gonadotropin (β-hCG) level
between 4 and 7 days after single dose MTX administration. In all cases, the
rate of emergency surgery after treatment was 9.3%.

Conclusion: In our study,
success rates in patients with EP treated with MTX were 80% after a single dose
and as high as 90.7% when a second dose was added.

Anahtar Kelimeler

Ectopic pregnancy, medical treatment, methotrexate

Kaynakça

• REFERENCES1. Kirk E, Bourne T. Ectopic pregnancy. Obstet Gynecol Reprod Med 2011; 21:207–11
• 2. Stovall TG, McCord ML. Early pregnancy lost and ectopic pregnancy. In: Berek JS, Adashi EY, Hillard PA, editors. Novak’s Gynecology (12th ed). Maryland: Williams&Wilkins; 1996. p. 487–523.
• 3. Cunningham FG, MacDonald PC, Gant NF, Leveno KJ, Gilstrap LC, Hankins GDF, Clark SL. Williams Obstetrics (20th ed). New Jersey: Prentice Hall International, Inc.; 1997. p. 607–34.
• 4. Condous G. The management of early pregnancy complications. Best Pract Res Clin Obstet Gynaecol 2004; 18:37–57.
• 5. Ackerman TE, Levi CS, Dashefsky SM. Interstitial line: sonographic finding in interstitial (cornual) ectopic pregnancy. Radiology 1993; 189:83–7.
• 6. Schwartz RO, Di Pietro DL. B-hCG as a diagnostic aid for suspected ectopic pregnancy. Obstet Gynecol 1980; 56:197-203.
• 7. Lawlor HK, Rubin BJ. Early diagnosis of ectopic pregnancy. West J Med 1993; 159:195–9.
• 8. Mayor S. Early diagnosis of ectopic pregnancy is essential to reduce deaths, says guideline. BMJ 2016; 355:i5954.
• 9. 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; 101:778–84.
• 10. Sowter MC, Farquhar CM, Petrie KJ, Gudex G. A randomised trial comparing single dose systemic methotrexate and laparoscopic surgery for the treatment of unruptured tubal pregnancy. BJOG 2001; 108:192-203.
• 11. Seeber BE, Barnhart KT (2006) Suspected ectopic pregnancy. Obstet Gynecol 107:399–413.
• 12. Stovall TG, Ling FW, Gray LA. Single-dose methotrexate for treatment of ectopic pregnancy. Obstet Gynecol 1991; 77:754-7.
• 13. Buster JE, Carson SA. Ectopic pregnancy; new advances in diagnosis and treatment. Curr Opinion Obstet Gynecol 1995; 7:168–76.
• 14. Lozeau AM, Potter B. Diagnosis and management of ectopic pregnancy. Am Fam Physician 2005; 72:1704-14.
• 15. Rana P, Kazmi I, Singh R, Afzal M, Al-Abbasi FA, Aseeri A, Singh R, Khan R, Anwar F. Ectopic pregnancy: a review. Arch Gynecol Obstet 2013; 288:747-57.
• 16. Nyberg DA, Filly RA, Laing FC, Mack LA, Zarutskie PW. Ectopic pregnancy. Diagnosis by sonography correlated with quantitative HCG levels. J Ultrasound Med 1987; 6:145–50.
• 17. Stika CS. Methotrexate: the pharmacology behind medical treatment for ectopic pregnancy. Clin Obstet Gynecol 2012; 55:433-9.
• 18. Kusgoz AG, Aka N, Coskun ADE, Kose G, Tufekcı EC, Vural F. Risk factors and treatment modalities in ectopic pregnancy cases. Haydarpaşa Numune Eğitim ve Araştırma Hastanesi Tıp Dergisi 2017; 57:1–5.
• 19. Shalev E, Peleg D, Tsabari A, Romano S, Bustan M. Spontaneous resolution of ectopic tubal pregnancy: natural history. Fertil Steril 1995; 63:15–9.
• 20. Lozeau AM, Potter B. Diagnosis and management of ectopic pregnancy. Am Fam Physician 2005; 72:1707–1714.
• 21. Aybatlı A, Kaplan PB, Alicik M, Sayın NC, Yuce MA. Single dose methotrexate in treatment of ectopic pregnancy: Review of 32 cases. Balkan Med J 2011; 28: 10–3
• 22. Yenen MC, Dede M, Göktolga Ü, Küçük T, Alanbay İ, Pabuçcu R. Ektopik gebelikte risk faktörleri. Gülhane Tıp Dergisi, 2003; 45:244–8.
• 23. Butts S, Sammel M, Hummel A, Chittams J, Barnhart K. Risk factors and clinical features of recurrent ectopic pregnancy: a case control study. Fertil Steril, 2003; 80: 1340–4.
• 24. Karaer A, Avşar F A, Batıoğlu S. Risk factors for ectopic pregnancy: a case control study. ANZJOG, 2006; 46:521–7.
• 25. Bacanakgil H, Unal F, Celik S, Bilgi A, Boran B. The results of risk factors and clinical findings of ectopic pregnancy. İstanbul Tıp Dergisi 2008; 4:182–6.