Conservative treatment of unruptured ectopic pregnancy in jamaica. A cornual pregnancy is an ectopic pregnancy that develops in the interstitial portion of the fallopian tube, invading through the uterine wall. In the united kingdom nearly 12 000 ectopic pregnancies are diagnosed each year, which gives a prevalence of 1. Mifepristone in combination with methotrexate for the. Risk factors for ectopic pregnancy include a previous ectopic pregnancy, the presence of tubal damage from an infection or prior abdominalpelvic surgery, a history of infertility, treatment for in vitro fertilization, increased maternal age and smoking 5. In conclusion, this study showed that medical treatment of ectopic pregnancy with systemic singledose methotrexate seems to be an option for some patients with unruptured tubal pregnancy.
Methotrexate with citrovorum factor rescue has shown promise in small case series as a treatment for unruptured ectopic pregnancy. If ectopic pregnancy appears unlikely and patients are stable, serum levels of betahcg can be measured serially on an outpatient basis typically every 2 days. Methotrexate for the treatment of unruptured tubal ectopic pregnancy volume 21 issue 3 k hawrylyshyn, sl mcleod, j thomas, catherine varner. Methotrexate and citrovorum were given on alternating days until the hcg titer had decreased by 15% on 2 consecutive days. The principals of diagnosis of a ruptured ectopic pregnancy, as stated in the. Among 119 cases of unruptured ectopic pregnancies diagnosed from april 1999 to february 2004, 57 received systemic treatment with. Singledose methotrexate for the treatment of unruptured. Among the 32 study patients, the diagnosis of ectopic pregnancy was made by sonography in nine 28. A second injection was needed in four 16% cases in the methotrexate group and in one 4% case in the combination group. An early ectopic pregnancy without unstable bleeding is most often treated with a medication called methotrexate, which stops cell growth and dissolves existing cells. Methotrexate and citrovorum were given on alternating days until the hcg titer had decreased by. Ectopic pregnancy diagnosis and treatment mayo clinic.
One out of every 100 to 300 pregnancies is ectopic, and the prevalence is increasing. Direct diagnosis of unruptured ectopic pregnancy by real. Less commonly, the ovaries, cervix or peritoneal cavity can be involved. 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 condition is the leading cause of pregnancy related death in the first trimester. Only a few health care providers request for these tests. Ectopic pregnancy gynecology and obstetrics msd manual. Diagnosing unruptured ectopic pregnancy sciencedirect. In a normal pregnancy, the fertilized egg moves from the fallopian tube into the uterus, where the pregnancy develops. The rates of unruptured ectopic pregnancy are very low at the kbth compared to the developed countries 8, 9, 10 even though the diagnostic aids for the detection of unruptured ectopic pregnancy have been available in ghana for many years. The medical treatment of unruptured ectopic pregnancy with. Making decisions using nice guidelines explains how we use words to show the. In a small percentage of pregnancies, however, the embryo implants in.
Furthermore, with earlier diagnosis, medical therapy with methotrexate can be offered and surgery avoided in some women, though the. Diagnosis of unruptured ectopic pregnancy is still uncommon. The diagnosing of ectopic pregnancy consistently leads to two different situations. Ectopic pregnancies cannot be carried to term and eventually rupture or involute. A read is counted each time someone views a publication summary such as the title, abstract, and list of authors, clicks on a figure, or views or downloads the fulltext. Unruptured tubal pregnancy in the second trimester mame diarra ndiaye gueye a, mamour gueye, ibou thiamb, magatte mbayea, abdou magib gayeb, abdoul aziz diouf a, mouhamadou mansour niang, jean charles moreaua introduction the incidence of ectopic pregnancies varies from 10 to 39. Ninetyfive percent of ectopic pregnancies occur in the fallopian tube, ampulla being the most common site. 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. Pdf clinical treatment of unruptured ectopic pregnancy. This study in 100 women aged 16 to 40 years better delineates the outcomes of such therapy. Sep 28, 2017 ectopic pregnancy is the result of a flaw in human reproductive physiology that allows the conceptus to implant and mature outside the endometrial cavity see the image below, which ultimately ends in the death of the fetus. The medical treatment of unruptured ectopic pregnancy with methotrexate and citrovorum rescue.
The use of ultrasonography increased the number of unruptured ectopic pregnancies from 0. An ectopic pregnancy occurs when a fertilized egg implants itself outside of the uterus. Ectopic pregnancy is an important cause of morbidity and mortality worldwide. Singledose versus twodose administration of methotrexate. Diagnosis and management of ectopic pregnancy american.
In jamaica during 3 years 1981 to 1983, ten percent of maternal deaths were from ectopic pregnancy 4. The history of the diagnosis and treatment of ectopic pregnancy. Pdf on oct 26, 2011, julio elito junior and others published clinical treatment of unruptured ectopic pregnancy find, read and cite all the research you. All charts of patients with ectopic pregnancies from 1 january 1986 to 31 december 1990 were analyzed. Of 612 patients with a suspected ectopic pregnancy at initial ed presentation, 326 53.
Jun 25, 2017 ectopic pregnancy is the leading cause of maternal death in early pregnancy. Epidemiology the overall incidence has increased over the last few decades and is currently thought to affect 12% of pregnancies. One out of three women who have had one ectopic pregnancy can have a baby in the future. Cornual pregnancies often rupture later than other tubal pregnancies because the myometrium is thick and more distendable than the fallopian tubes are. Among 23 patients with negative findings on sonography, only one was found on followup to have an ectopic pregnancy, for a 96% diagnostic accuracy for. However, at the korle bu teaching hospital kbth, studies done in the past three decades reported unruptured ectopic pregnancy rates of 1. Its very important that the diagnosis of ectopic pregnancy is certain before receiving this treatment. Ectopic pregnancy refers to the implantation of a fertilised ovum outside of the uterine cavity. The classic triad of symptoms, amenorrhea, abdominal pain, and abnormal bleeding, varies greatly among individuals, and ectopic pregnancies frequently are confused with other conditions, such as ovarian cyst, pelvic inflammatory disease, and spontaneous abortion. Seethapathy nagar, velacherry, chennai600042 corresponding author abstract introduction ectopic pregnancy is one of the most common gynaecological emergencies.
Direct diagnosis of unruptured ectopic pregnancy by realtim. An ectopic pregnancy is any pregnancy which is implanted at a site outside of the uterine cavity. Ectopic pregnancy journal of obstetric, gynecologic. Apr 20, 2015 value 25ngml normal intrauterine pregnancy value pregnancy extrauterine pregnancy most of ectopic pregnancy value ranges 1025 ngml 32. Ectopic pregnancy affects 1% to 2% of all pregnancies and is responsible for 9% of pregnancyrelated deaths in the united states.
Meanwhile the methods of aiding in the diagnosis of unruptured ectopic pregnancy have been avail. Followup surgery confirmed the diagnosis in eight 89%. In vitro fertilisation and fertility treatments sexually transmitted infections e. In ectopic pregnancy, implantation occurs in a site other than the endometrial lining of the uterine cavityin the fallopian tube, uterine cornua, cervix, ovary, or abdominal or pelvic cavity. Methotrexate for the treatment of unruptured tubal ectopic. In an ongoing clinical trial, 100 patients with an unruptured ectopic pregnancy of 3. Ectopic pregnancy gynecology and obstetrics merck manuals.
Pdf about 1% of pregnancies are ectopic, usually implants in the fallopian tube. Hemodynamically stable patients with ectopic pregnancies are commonly treated with systemic methotrexate lipscomb et al. The management of those patients who had transabdominal ultrasonography was compared with those who had not. Currently, diagnosis in unruptured ectopic pregnancy is achieved using a combination of transvaginal ultrasonography and measurement of serum. Without timely diagnosis and treatment, ectopic pregnancy can become a lifethreatening situation. Theyre also called tubal pregnancies because most of them happen in the fallopian tubes. The likelihood of a successful pregnancy after an ectopic pregnancy depends on. The incidence of ectopic pregnancy ep has been increasing recently. The diagnosis of unruptured ectopic pregnancy was nearly impossible. Nonsurgical diagnosis and management of ectopic pregnancy.
Pdf singledose methotrexate for unruptured ectopic. To compare the effectiveness of singledose methotrexate mtx and laparoscopic salpingostomy in the treatment of unruptured ectopic pregnancy uep. Unruptured left cornual ectopic pregnancy journal of. Methotrexate treatment of unruptured ectopic pregnancy. Surgical management of unruptured ectopic pregnancy. Ectopic pregnancy is defined as implantation of a fertilized egg outside the uterine cavity. Use of transvaginal ultrasonography and quantitative measurement of the.
Out of 119 patients with unruptured ectopic pregnancy, 62 had decreasing betahcg levels and were managed expectantly and 57 had serum betahcg levels that increased or were maintained over 24 and 48hour intervals and were treated with methotrexate 50 mgm 2 intramuscularly. Outpatient chemotherapy of unruptured ectopic pregnancy. One hundred sixteen laparoscopically documented eps, the majority 90% of whom were symptomatic, were diagnosed from an emergency department popu lation. Diagnosis and management of ectopic pregnancy the bmj. Ectopic pregnancy affects 1% to 2% of all pregnancies and is responsible for 9% of pregnancy related deaths in the united states. In a normal pregnancy, the egg is fertilized in your fallopian tube. Unruptured ectopic pregnancy julio elito junior professor at the obstetrics department of the federal university of sao paulo brazil 1. Nov 01, 2005 ectopic pregnancy is a highrisk condition that occurs in 1. One of the key elements in the diagnosis is the exclusion of a viable or nonviable iup. It then travels through the tube and lands in the uterus, where it starts growing. In many cases the symptoms have low specificity, and can be similar to those of other genitourinary and gastrointestinal disorders, such as appendicitis, salpingitis, rupture of a corpus luteum cyst, miscarriage, ovarian torsion or urinary tract infection. Most ectopic pregnancy ep continues to grow and lead to. An economic evaluation of single dose systemic methotrexate and laparoscopic surgery for the treatment of unruptured ectopic pregnancy. The most common sites include the ampulla and isthmus of the fallopian tube.
This is due primarily to better diagnostic testing, such as the. Diagnosis and exact location of ectopic pregnancy is usually easy during the first trimester of pregnancy by ultrasonography. Value 25ngml normal intrauterine pregnancy value pdf and any associated supplements and figures for a period of 48 hours. Introduction ectopic pregnancy is a major public health problem worldwide. Diagnosis of unruptured ectopic pregnancy is still.
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