Singledose mtx treatment failure based on hcg level. It is frequently associated with pelvic inflammat ectopic pregnancy knowledge for medical students and physicians. Ectopic pregnancy affects 11 in pregnancies and is a significant cause of morbidity and at times mortality in the first trimester of pregnancy. To understand recent advances in diagnosis and conservative laparoscopic and medical treatment. Ectopic pregnancy is a pregnancy where the fertilized ovum is implanted and grows outside of the uterine cavity endometrium. Methotrexate, a folic acid antagonist, is an effective treatment for early unruptured ectopic pregnancy. Asrm practice committee, fertility and sterility 2008, medical management of ectopic pregnancy. Purpose and scope the purpose of this guideline is to improve the management of women who may have an ectopic pregnancy. The most common site for an ectopic pregnancy is the fallopian tube one of the tubes connecting the ovaries to the uterus. In clinically stable women in whom a nonruptured ectopic pregnancy has been diagnosed, laparoscopic surgery or intramuscular methotrexate administration are safe and effective treatments. Four cases 19% who received single dose of inj methotexate underwent surgery having failed medical treatment for tubal abortiontubal rupture. Most cases occur in the fallopian tube and are thus sometimes called tubal pregnancies. Ectopic pregnancy is a significant cause of morbidity and mortality in the first trimester of pregnancy. Ectopic pregnancy treatment algorithm bmj best practice.
In this study, we aimed to investigate the efficacy of lower mtx doses in the treatment of ectopic pregnancy. In addition, because medical therapy has made outpatient treatment the norm in most cases, it has become virtually impossible to chart the prevalence of ectopic pregnancy. If you have medical treatment, you will be advised to wait three months before trying for another pregnancy. Medicine that ends the pregnancy, along with close monitoring by your doctor. Ectopic pregnancy is usually diagnosed in the first trimester of pregnancy.
Sep 28, 2017 the medical treatment of ectopic pregnancy requires compulsive compliance. Ectopic pregnancy occurs when an embryo attaches outside of the uterus, most commonly in the fallopian tubes. It is important for both the pregnant woman and the health care provider to identify any signs and symptoms of an ectopic pregnancy before rupture. Effort should be made to diagnose ectopic pregnancy definitively before medical treatment with mtx. Most cases of tubal ectopic pregnancy that are detected early can be treated successfully either with minimally invasive surgery or with medical management. Treatment medical treatment protocols for mtx were established in the late 1980s and have become a widely accepted primary treatment for ectopic pregnancy 2731. A drug methotrexate is given as an injection this prevents the ectopic pregnancy from. Does medical treatment of ectopic pregnancy with methotrexate have better subsequent fertility outcomes than surgical treatment. Women of reproductive age presenting acutely with gastrointestinal symptoms, particularly diarrhoea, as well as those presenting with abdominal pain andor vaginal bleeding should have a urinary hcg test.
The chances of having a successful pregnancy after an ectopic pregnancy may be reduced, but this will depend on why the pregnancy was ectopic and your medical history. Medical management of ectopic pregnancy sciencedirect. Treatment of ectopic pregnancy with methotrexate is not. Depending on your symptoms and when the ectopic pregnancy is discovered, this may be done using medication, laparoscopic surgery or abdominal surgery. The most common gestational age at diagnosis is 6 to 10 weeks, but fetal viability can be discovered until the time of delivery. Ectopic pregnancies are unsafely outside of your uterus usually in the fallopian tubes, and are removed with a medicine called methotrexate or through a laparoscopic. Jun 25, 2017 ectopic pregnancy is the leading cause of maternal death in early pregnancy. The physician must emphasize the importance of patient followup and have patient information on hand, including the patients home address, telephone numbers at home and work, and the means to reach a contact person in case attempts to reach the patient directly are unsuccessful. Medical treatment of ep is quite less expensive than surgery. Usually, a baby grows in the uterus or womb the hollow, pearshaped organ in the pelvis during pregnancy.
A second injection was needed in four 16% cases in the methotrexate group and in one 4% case in the combination group. During ovulation, an egg ovum is released from one of the ovaries. Medical treatment methotrexatefolic acid analog, inhibits dihydrofolate reductase and halting dna synthesis. Diagnosis and management of ectopic pregnancy mcgill university. Nov 01, 2005 ectopic pregnancy is a highrisk condition that occurs in 1. It used to be that about 90% of women with ectopic pregnancies had to have surgery.
The treatment should performed surgically if the patient is hemodynamically unstable. After an ectopic pregnancy has been confirmed, treatment options include medical, surgical, or expectant management. Patients who underwent surgical management were treated with blood transfusion, antibiotics and supportive care. After laparoscopic treatment of ectopic pregnancy saint.
However, there is a limited number of studies investigating lower mtx doses. The incidence of ectopic pregnancy has been rising over the last 20 years. It represents a serious hazard to a womans health and reproductive potential, requiring prompt recognition and early aggressive intervention. Early diagnosis of ectopic pregnancy has allowed medical treatment of this condition with methotrexate. This booklet is designed to provide information on the diagnosis and treatment of ectopic pregnancy. Diagnosis and management of ectopic pregnancy aafp. New 2016 d women with a previous history of subfertility should be advised that treatment of their tubal ectopic pregnancy with expectant or medical management is associated with improved. In a normal pregnancy, the fertilized egg moves from the fallopian tube into the uterus, where the pregnancy develops.
The estimated success rate for medical treatment of interstitial pregnancy is lower than that for treatment of ectopic pregnancies located in the tubal ampulla or isthmus 52 x 52 barnhart, k. Given its convenience, for many it is used as a firstline treatment, however, this is. If the ectopic pregnancy has not ruptured, treatment may include. Abortion is a medical procedure that when done safely, ends a pregnancy thats in your uterus. Medical treatment of ectopic pregnancy fertility and. Diagnosis and management of ectopic pregnancy american. Given its convenience, for many it is used as a first line treatment, but this is not always the optimal choice for the patient.
Ectopic pregnancy diagnosis and treatment mayo clinic. Given its convenience, for many it is used as a firstline treatment, however, this is not always the optimal choice for the patient. In certain circumstances, an ectopic pregnancy may be treated by medication drugs. Symptoms can include cramping, abdominal pain and vaginal bleeding. Ectopic pregnancy can be very difficult to diagnose.
Many unruptured ectopic pregnancies can be managed with either surgery or methotrexate. Medical treatment of interstitial pregnancy a report of three unsuccessful cases. Links to pubmed are also available for selected references. Medical treatment of ectopic pregnancy springerlink. Ectopic pregnancy knowledge for medical students and. The use of methotrexate to treat ectopic pregnancy was first cited in 1982. Pdf the diagnosis and treatment of ectopic pregnancy. There was also a secondary finding of a corpus luteum cyst. After laparoscopic treatment of ectopic pregnancy you were diagnosed with ectopic pregnancy, a pregnancy that develops outside the uterus womb. Nov 11, 20 we welcome the recently published article by the practice committee of the american society for reproductive medicine on the medical treatment of ectopic pregnancy ep 1. A ruptured fallopian tube is a medical emergency needing immediate treatment. The multipledose protocol alternates mtx 1 mgkg treatment with leucovorin 0.
Treatment is usually needed to remove the pregnancy before it grows too large. Ectopic pregnancy is defined as implantation of a fertilized egg outside the uterine cavity. When medical treatment fails despite four doses of methotrexate, increasing trend of. In past years, when hospital records were used, ectopic pregnancy rates were increasing relentlessly, from 4. Early treatment of an ectopic pregnancy can help preserve the chance for future healthy pregnancies. Hemorrhage from ectopic pregnancy is still the leading cause of pregnancy related maternal mortality in the first. The development of algorithms for diagnosis and medical management using mtx has.
Medical treatment for a suspected ectopic pregnancy without a definitive diagnosis does not reduce complication rates or cost because many women with undiagnosed miscarriage would otherwise be exposed to mtx and its side effects unnecessarily 20 x 20 barnhart, k. Treating an ectopic pregnancy the ectopic pregnancy trust. Left untreated, lifethreatening blood loss is possible. For patients who are medically unstable or experiencing lifethreatening. It is important to understand the options for medical treatment and when it is. Jan 08, 2018 an untreated ectopic pregnancy can be a medical emergency. The decision for surgical or medical management of ectopic pregnancy should be guided by the initial clinical, laboratory, and radiologic data as well as. These are all rare conditions with individualised treatment. This topic will focus mainly on the diagnosis of tubal pregnancy. Potential consequences of medical management of a presumed ectopic pregnancy include 1. Clinical practice guideline the diagnosis and management of ectopic pregnancy 3 key recommendations 1. Currently, a high index of suspicion, serial hormone assays, and transvaginal ultrasonography tvu facilitate the diagnosis and treatment of ectopic pregnancy before rupture occurs. Practice committee of the american society of reproductive medicine. Learn more from webmd about the symptoms, causes, and treatment of an.
However, treatment practices may also differ depending on physicians and hospitals legal, religious, or moral objection to removal of a tubal pregnancy, viewed by some in the medical community as an abortion. Medical treatment is useful for patients with an unruptured tubal ectopic pregnancy who are haemodynamically stable and have minimal symptoms and a low volume of free intraperitoneal fluid on ultrasound scan. Risk factors most strongly associated with ectopic pregnancy include previous ecto. Folic acid normally is reduced to tetrahydrofolate by the enzyme dihydrofolate reductase dhfr, a step in the synthesis of dna and rna. Medical treatment of ectopic pregnancy fertility and sterility. Medical management has become increasingly popular in the treatment of ectopic pregnancy. To prevent lifethreatening complications, the ectopic tissue needs to be removed. If you have been diagnosed as having an ectopic pregnancy and are stable, with pulse and blood pressure within normal limits, and there is no heavy bleeding or severe pain, and if there are no signs of dizziness or fainting, the doctor will be able to discuss various treatment options with you. Medical treatment of ectopic pregnancy sciencedirect. It is for use by all healthcare professionals involved in womens. Ectopic pregnancy current management guidelines ectopic pregnancy remains the leading cause of death in early trimester of pregnancy. Depending on location, a combination of medical and.
In a small percentage of pregnancies, however, the embryo implants in. A decrease in beta hcg by more than 15% between day 4 and day 7 after treatment shows successful medical treatment. Medical treatment for a suspected ectopic pregnancy without a definitive diagnosis does not reduce complication rates or cost because many women with undiagnosed miscarriage would otherwise be exposed to mtx and its side effects unnecessarily 20, 23. The criteria of methotrexate treatment include hemodynamic stability, ability to comply with followup, serum human chorionic gonadotropin hcg treatment of ectopic pregnancy with methotrexate page 2 of 3 rev 20120611 if it is determined that you have an ectopic pregnancy, you may be a candidate for medical nonsurgical management of the pregnancy. Webmd does not provide medical advice, diagnosis or treatment. Treating an ectopic pregnancy isnt the same thing as getting an abortion.
Prompt treatment reduces your risk of complications from the ectopic pregnancy, increases your chances for future, healthy pregnancies. An ectopic pregnancy occurs when an embryo implants somewhere other than the uterus, such as in one of the fallopian tubes. Oct 11, 2005 historical features and physical findings. In indonesia, the incidence of ectopic pregnancy is around 56 per. Women who underwent ectopic pregnancy are advised to avoid getting pregnant for a year after the incident because there is a 10% to 20% chance of a subsequent ectopic pregnancy. Full text full text is available as a scanned copy of the original print version. The multipledose protocol is a regimen adapted from early experience with mtx treatment for trophoblastic disease and was the regimen first used to treat ectopic pregnancy 27, 28. In selected patients methotrexate mtx is an effective treatment for unruptured ep and helps to avoid surgical intervention. The condition is the leading cause of pregnancy related death in the first trimester. Medical treatment is useful for patients with an unruptured tubal ectopic pregnancy who are hemodynamically stable and have minimal symptoms and a low volume of free intraperitoneal fluid on ultrasound scan. Case the patients presenting symptoms, combined with a positive pregnancy test.
The location of an ectopic pregnancy may alter the approach to treatment and subsequent followup. Mifepristone in combination with methotrexate for the medical. Definition ectopic pregnancies account for one to two percent of all conceptions. A fertilized egg cant develop normally outside the uterus. Management of ectopic pregnancy department of gynaecology. What is methotrexate treatment for ectopic pregnancy. An ectopic pregnancy occurs when the fertilized egg attaches itself in a place other than inside the uterus. Ectopic pregnancy refers to the pregnancy occurring outside the uterine cavity, predominantly i. Definition ectopic pregnancies account for 1% to 2% of all conceptions. Ectopic pregnancy is a pregnancy that develops outside the uterus, usually in one of the fallopian tubes. The ethical and religious directives for catholic health care services the directives issued by the.
If the fallopian tubes have been left in place, you have approximately a 60% chance of having a successful pregnancy. The medical treatment of ectopic pregnancy requires compulsive compliance. Get a printable copy pdf file of the complete article 255k, or click on a page image below to browse page by page. There are very few publications collecting all management strategies,including both surgical and medical treatment,for this dangerous type of ectopic pregnancy. The developing cells must be removed to save the mothers life. Typically presents 68 weeks after last normal menstrual period, but can present earlier or later. Both treatment protocols were successful in achieving the resolution of unruptured ectopic pregnancy 1825 in the methotrexate group and 2225 in the combination group following the initial intervention. Methotrexate mtx treatment at a dose of 50 mgm 2 of body surface area bsa is an effective and widely used treatment method in ectopic pregnancy. Up to 10% of women with ectopic pregnancy have no symptoms, and onethird have no medical signs.
35 300 1338 156 711 571 587 384 1611 490 973 754 151 1273 233 1105 1359 1533 548 1477 1382 1196 290 509 69 1347 1128 1400 314