Medical treatment of interstitial pregnancy a report of three unsuccessful cases. 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. Medical treatment of ectopic pregnancy sciencedirect. It is frequently associated with pelvic inflammat ectopic pregnancy knowledge for medical students and physicians. There are very few publications collecting all management strategies,including both surgical and medical treatment,for this dangerous type of ectopic pregnancy. 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. If the ectopic pregnancy has not ruptured, treatment may include. Hemorrhage from ectopic pregnancy is still the leading cause of pregnancy related maternal mortality in the first. 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. Methotrexate, a folic acid antagonist, is an effective treatment for early unruptured ectopic pregnancy. Given its convenience, for many it is used as a firstline treatment, however, this is. Potential consequences of medical management of a presumed ectopic pregnancy include 1. Usually, a baby grows in the uterus or womb the hollow, pearshaped organ in the pelvis during pregnancy.
Given its convenience, for many it is used as a firstline treatment, however, this is not always the optimal choice for the patient. It represents a serious hazard to a womans health and reproductive potential, requiring prompt recognition and early aggressive intervention. If the fallopian tubes have been left in place, you have approximately a 60% chance of having a successful pregnancy. 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. 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. 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. Links to pubmed are also available for selected references. Nov 01, 2005 ectopic pregnancy is a highrisk condition that occurs in 1. Sep 28, 2017 the medical treatment of ectopic pregnancy requires compulsive compliance. 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. Medical management of ectopic pregnancy sciencedirect. 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.
The incidence of ectopic pregnancy has been rising over the last 20 years. It used to be that about 90% of women with ectopic pregnancies had to have surgery. After laparoscopic treatment of ectopic pregnancy you were diagnosed with ectopic pregnancy, a pregnancy that develops outside the uterus womb. Jun 25, 2017 ectopic pregnancy is the leading cause of maternal death in early pregnancy. However, there is a limited number of studies investigating lower mtx doses. 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. Case the patients presenting symptoms, combined with a positive pregnancy test. Jan 08, 2018 an untreated ectopic pregnancy can be a medical emergency. Symptoms can include cramping, abdominal pain and vaginal bleeding. If you have medical treatment, you will be advised to wait three months before trying for another pregnancy. During ovulation, an egg ovum is released from one of the ovaries.
A ruptured fallopian tube is a medical emergency needing immediate treatment. In certain circumstances, an ectopic pregnancy may be treated by medication drugs. This topic will focus mainly on the diagnosis of tubal pregnancy. Asrm practice committee, fertility and sterility 2008, medical management of ectopic pregnancy. Treatment is usually needed to remove the pregnancy before it grows too large.
After an ectopic pregnancy has been confirmed, treatment options include medical, surgical, or expectant management. Diagnosis and management of ectopic pregnancy american. 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. 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. A second injection was needed in four 16% cases in the methotrexate group and in one 4% case in the combination group.
Treating an ectopic pregnancy the ectopic pregnancy trust. Ectopic pregnancy is a pregnancy where the fertilized ovum is implanted and grows outside of the uterine cavity endometrium. Most cases occur in the fallopian tube and are thus sometimes called tubal pregnancies. Given its convenience, for many it is used as a first line treatment, but this is not always the optimal choice for the patient. The most common site for an ectopic pregnancy is the fallopian tube one of the tubes connecting the ovaries to the uterus. Risk factors most strongly associated with ectopic pregnancy include previous ecto. Medical management has become increasingly popular in the treatment of ectopic pregnancy. Medical treatment of ectopic pregnancy fertility and. To understand recent advances in diagnosis and conservative laparoscopic and medical treatment. Treatment of ectopic pregnancy with methotrexate is not.
Clinical practice guideline the diagnosis and management of ectopic pregnancy 3 key recommendations 1. Diagnosis and management of ectopic pregnancy aafp. The medical treatment of ectopic pregnancy requires compulsive compliance. A drug methotrexate is given as an injection this prevents the ectopic pregnancy from. 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. In indonesia, the incidence of ectopic pregnancy is around 56 per. A fertilized egg cant develop normally outside the uterus. Prompt treatment reduces your risk of complications from the ectopic pregnancy, increases your chances for future, healthy pregnancies. Effort should be made to diagnose ectopic pregnancy definitively before medical treatment with mtx. Patients who underwent surgical management were treated with blood transfusion, antibiotics and supportive care. Ectopic pregnancy occurs when an embryo attaches outside of the uterus, most commonly in the fallopian tubes. 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. Left untreated, lifethreatening blood loss is possible. Ectopic pregnancy is a significant cause of morbidity and mortality in the first trimester of pregnancy. The development of algorithms for diagnosis and medical management using mtx has. Singledose mtx treatment failure based on hcg level. Folic acid normally is reduced to tetrahydrofolate by the enzyme dihydrofolate reductase dhfr, a step in the synthesis of dna and rna. The location of an ectopic pregnancy may alter the approach to treatment and subsequent followup. Ectopic pregnancy can be very difficult to diagnose. Medicine that ends the pregnancy, along with close monitoring by your doctor. Ectopic pregnancy affects 11 in pregnancies and is a significant cause of morbidity and at times mortality in the first trimester of 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. Webmd does not provide medical advice, diagnosis or treatment. 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.
Pdf the diagnosis and treatment of ectopic pregnancy. Ectopic pregnancy is usually diagnosed in the first trimester of pregnancy. Ectopic pregnancy diagnosis and treatment mayo clinic. Definition ectopic pregnancies account for 1% to 2% of all conceptions. Abortion is a medical procedure that when done safely, ends a pregnancy thats in your uterus. 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. Treating an ectopic pregnancy isnt the same thing as getting an abortion. Ectopic pregnancy knowledge for medical students and. Diagnosis and management of ectopic pregnancy mcgill university. Treatment medical treatment protocols for mtx were established in the late 1980s and have become a widely accepted primary treatment for ectopic pregnancy 2731. The decision for surgical or medical management of ectopic pregnancy should be guided by the initial clinical, laboratory, and radiologic data as well as. The developing cells must be removed to save the mothers life.
Ectopic pregnancy is defined as implantation of a fertilized egg outside the uterine cavity. Most cases of tubal ectopic pregnancy that are detected early can be treated successfully either with minimally invasive surgery or with medical management. The treatment should performed surgically if the patient is hemodynamically unstable. 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. Ectopic pregnancy treatment algorithm bmj best practice. It is for use by all healthcare professionals involved in womens. 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. Oct 11, 2005 historical features and physical findings. Early diagnosis of ectopic pregnancy has allowed medical treatment of this condition with methotrexate.
An ectopic pregnancy occurs when the fertilized egg attaches itself in a place other than inside the uterus. The use of methotrexate to treat ectopic pregnancy was first cited in 1982. Many unruptured ectopic pregnancies can be managed with either surgery or methotrexate. Ectopic pregnancy refers to the pregnancy occurring outside the uterine cavity, predominantly i. After laparoscopic treatment of ectopic pregnancy saint.
Up to 10% of women with ectopic pregnancy have no symptoms, and onethird have no medical signs. When medical treatment fails despite four doses of methotrexate, increasing trend of. Medical treatment of ep is quite less expensive than surgery. The condition is the leading cause of pregnancy related death in the first trimester. Purpose and scope the purpose of this guideline is to improve the management of women who may have an ectopic pregnancy. Ectopic pregnancy current management guidelines ectopic pregnancy remains the leading cause of death in early trimester of pregnancy. Mifepristone in combination with methotrexate for the medical.
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. The most common gestational age at diagnosis is 6 to 10 weeks, but fetal viability can be discovered until the time of delivery. In this study, we aimed to investigate the efficacy of lower mtx doses in the treatment of ectopic pregnancy. Get a printable copy pdf file of the complete article 255k, or click on a page image below to browse page by page. For patients who are medically unstable or experiencing lifethreatening. Depending on location, a combination of medical and. Definition ectopic pregnancies account for one to two percent of all conceptions. Early treatment of an ectopic pregnancy can help preserve the chance for future healthy pregnancies. Does medical treatment of ectopic pregnancy with methotrexate have better subsequent fertility outcomes than surgical treatment. Ectopic pregnancy is a pregnancy that develops outside the uterus, usually in one of the fallopian tubes. Typically presents 68 weeks after last normal menstrual period, but can present earlier or later. Medical treatment of ectopic pregnancy fertility and sterility.
Nov 18, 2017 when medical treatment fails despite four doses of methotrexate, increasing trend of. This booklet is designed to provide information on the diagnosis and treatment of ectopic pregnancy. Depending on your symptoms and when the ectopic pregnancy is discovered, this may be done using medication, laparoscopic surgery or abdominal surgery. What is methotrexate treatment for ectopic pregnancy.
To prevent lifethreatening complications, the ectopic tissue needs to be removed. An ectopic pregnancy occurs when an embryo implants somewhere other than the uterus, such as in one of the fallopian tubes. Medical treatment of ectopic pregnancy springerlink. Currently, a high index of suspicion, serial hormone assays, and transvaginal ultrasonography tvu facilitate the diagnosis and treatment of ectopic pregnancy before rupture occurs. In past years, when hospital records were used, ectopic pregnancy rates were increasing relentlessly, from 4. 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. Medical treatment methotrexatefolic acid analog, inhibits dihydrofolate reductase and halting dna synthesis. It is important to understand the options for medical treatment and when it is. In a normal pregnancy, the fertilized egg moves from the fallopian tube into the uterus, where the pregnancy develops.
Risk increases with prior ectopic pregnancy, tubal surgery, history of sexually transmitted infections, smoking, in vitro fertilization, or if pregnant despite iud usage. These are all rare conditions with individualised treatment. In selected patients methotrexate mtx is an effective treatment for unruptured ep and helps to avoid surgical intervention. Practice committee of the american society of reproductive medicine. Full text full text is available as a scanned copy of the original print version. The ethical and religious directives for catholic health care services the directives issued by the. Learn more from webmd about the symptoms, causes, and treatment of an.
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