Outcome of Laparoscopic Management of Undisturbed Ectopic Pregnancy Versus Medical Management
Journal of Advances in Medicine and Medical Research,
Page 197-204
DOI:
10.9734/jammr/2022/v34i1931453
Abstract
Background: Ectopic pregnancy (EP) is major health problem that women experience during reproductive years. The most frequent type of EP is tubal pregnancy, while non-tubal and heterotopic extra-uterine pregnancies are rare. Recently; ectopic pregnancy can be diagnosed before patient's clinical state is worsened.
Aim: was to compare outcome of laparoscopic therapy of undisturbed adenexial ectopic pregnancy versus medical therapy by methotrexate.
Methods: This randomized controlled clinical study on 50 patients attending outpatient clinic and inpatient at Department of Obstetrics and Gynecology -Tanta University Hospital. The study participants included women who underwent laparoscopy or underwent medical therapy with MTX for undisturbed adenexial ectopic pregnancy. We analyzed data of 50 women 25treated with single dose MTX and 25 cases treated with laparoscopy for undisturbed adenexial ectopic pregnancy between 2020and 2021. Success of treatment in laparoscopy group was defined as significant decrease in one week post-therapeutic quantitative β- HCG, while in MTX group success of treatment was defined as decrease in BHCG level more than15% between day 4 and day 7, with no need for surgical intervention..
Results: Success of treatment in laparoscopy group (23cases, 92%) and (18 cases, 72%) in methotrexate group, no statistically significant difference between two groups (p=0.306). In methotrexate group the 7 cases who had failed medical therapy, underwent laparoscopy. There was no statistically significant difference between the two groups regarding persistent trophoblast (p=0.490), as two (8%) cases in laparoscopy group, while no cases in methotrexate group.
Conclusions: Laparoscopic surgery is as effective as methotrexate therapy for conservative therapy of undisturbed adenexial ectopic pregnancy and methotrexate has advantage of being non-invasive procedure.
Keywords:
- Ectopic pregnancy
- methotrexate
- salpingostomy
How to Cite
References
Barnhart KT. Clinical practice. Ectopic pregnancy. N Eng l J Med. 2009;361:379.
Kirk E, Bottomley C, Bourne T. Diagnosing ectopic pregnancy and current concepts in the management of pregnancy of unknown location .Hum Reprod Update. 2014; 20:250–261.
Ankum WM, Mol BWJ, Van der Veen F, Bossuyt PMM. Risk factors for ectopic pregnancy: A meta-analysis. Fertil Steril. 1996;(65):1093–1099.
Mausner Geffen E, Slywotzky C, Bennett G. Pitfalls and tips in the diagnosis of ectopic pregnancy. Abdom Radiol. 2017; 42(5):1524–42.
Hajenius PJ, Mol F, Mol BW, Bossuyt PM, Ankum WM, van der Veen F. Interventions for tubal ectopic pregnancy. Cochrane Database Syst. Rev. 2007;2007(1).
French AE, Koren G. Effect of methotrexate on male fertility. Can Fam Physician. 2003;49:(577-8).
Stovall TG, Ling FW, Gray LA. Single-dose methotrexate for treatment of ectopic pregnancy. Obstet Gynecol. 1991;77 (5):754-7.
Louis St (MO): Wolters Kluwer; Methotrexate – injection. In: Drug facts and comparisons. 2017;3883–90.
Dubuisson JB, Morice P, Chapron C, De GA, Mouelhi T. salpingectomy-the laparoscopic surgical choice for ectopic pregnancy.HumReprod. 1996;(11):1199.
Cheng X, Tian X, Yan Z, Jia M, Deng J, Wang Y, Fan D. Comparison of the fertility outcome of salpingotomy and salpingectomy in women with tubal pregnancy: A Systematic review and meta-analysis. PLoS One. 2016;11(3).
Juneau C, Bates GW. Reproductive outcomes after medical and surgical management of ectopic pregnancy. Clin Obstet Gynecol. 2012;55:455–60.
Hajenius PJ, Engelsbel S, Mol BW, Van der Veen F, Ankum WM, Bossuyt PM, Hemrika DJ, Lammes FB. Randomised trial of systemic methotrexate versus laparoscopic salpingostomy in tubal pregnancy. Lancet. 1997;350(9080):774-9.
Saraj AJ, Wilcox JG, Najmabadi S, Stein SM, Johnson MB, Paulson RJ. Resolution of hormonal markers of ectopic gestation: A randomized trial comparing single dose intramuscular methotrexate with salpin-gostomy. Obstet Gynecol.1998;92:989-994.
Fernandez H, Capella-Allouc S, Vincent Y, Audibert F, Frydman R. Randomized trial of conservative laparoscopic treatment and methotrexate administration in ectopic pregnancy and subsequent fertility. Hum Reprod. 1998;13:3239-3243.
Krag Moeller LB, Moeller C, Thomsen SG, Andersen LF, Lundvall L, Lidegaard Ø, Kjer JJ, Ingemanssen JL, Zobbe V, Floridon C, Petersen J, Ottesen B. Success and spontaneous pregnancy rates following systemic methotrexate versus laparoscopic surgery for tubal pregnancies: A randomized trial. Acta Obstet Gynecol Scand. 2009;88(12):1331-7.
Sowter MC, Farquhar CM, Petrie KJ, Gudex G. A randomized trial comparing single dose systemic methotrexate and laparoscopic surgery for the treatment of unruptured tubal pregnancy.BJOG. 2001; 108(2):192-203.
Lewis-Bliehall C, Rogers RG, Kammerer-Doak DN, Conway SC, Amaya C, Byrn F. Medical vs. surgical treatment of ectopic pregnancy. The University of New Mexico's six year experience. J Reprod Med. 2001; 46(11):983-8.
Jurkovic D, Memtsa M, Sawyer E, Donaldson AN, Jamil A, Schramm K, Sana Y, Otify M, Farahani L, Nunes N, Ambler G, Ross JA. Single dose systemic methotrexate vs. expectant management for treatment of tubal ectopic pregnancy: a placebo-controlled randomized trial. Ultrasound Obstet Gynecol. 2017; 49(2):171-176.
Lavie G, Kais M, Tendler R, Marwan O, Bornstein J, Sharon A. Rate of hourly change in serum beta-human chorionic gonadotropin levels in ectopic pregnancy can predict the success of treatment with single-dose methotrexate: A retrospective observational study. Eur J Obstet Gynecol Reprod Biol. 2021;265:39-43.
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