Management outcomes of ectopic pregnancy depending on different treatment modalities: a cohort study

Background: Ectopic pregnancy is the most common cause of maternal morbidity and mortality during the first trimester of pregnancy. The present study aimed to review and evaluate the management outcomes of ectopic pregnancy in Damascus University Maternity Hospital, Syria.Methods: A retrospective cohort study was performed on women referring to Damascus University Hospital of Obstetrics and Gynecology (OBGYN) for ectopic pregnancy. Patients were assigned into groups by method of treatment: expectant management (Group 1), single-dose methotrexate regimen (Group 2), two-dose methotrexate regimen (Group 3), and surgical intervention (Group 4). Parameters assessed were risk factors for ectopic pregnancies, transvaginal ultrasonography findings, serum human chorionic gonadotropin (hCG) levels on Days 0, 4, 7, and types of surgical intervention in women that underwent any surgical intervention. A treatment modality was considered successful when hCG levels declined to less than 5 mIU/L without further administration of methotrexate dose or need for surgery.Results: Seventy-seven women with ectopic pregnancy were admitted to the hospital during the study period. Groups 1, 2, 3, and 4 constituted 20.8%, 13.0%, 6.5% and 59.7% of the patients respectively. The most common encountered risk factors for ectopic pregnancy in the patients were history of previous intra-abdominal or pelvic surgery (57.1%) and history of miscarriage (41.6%). A statistically significant difference in the serum hCG concentrations measured on day 0, day 4, and day 7 were observed between the groups.Conclusions: The success rate in ectopic pregnancy treatment was 56.25% for the expectant management, 70% for the single-dose methotrexate regimen, and 40% for two-dose methotrexate regimen.

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The Importance of Gestational Sac Size of Ectopic Pregnancy in Response to Single-Dose Methotrexate

ISRN Obstetrics and Gynecology ◽

10.1155/2013/269425 ◽

2013 ◽

Vol 2013 ◽

pp. 1-4

Author(s):

Parichehr Kimiaei ◽

Zahra Khani ◽

Azadeh Marefian ◽

Maryam Gholampour Ghavamabadi ◽

Maryam Salimnejad

Keyword(s):

Single Dose ◽

Confidence Interval ◽

Ectopic Pregnancy ◽

Baseline Level ◽

Surgical Intervention ◽

Dose Methotrexate ◽

Causal Pathway ◽

Gestational Sac ◽

Logistic Regressions ◽

Predictor Factors

This retrospective cohort study was designed in a selective group of 185 patients diagnosed with and treated for ectopic pregnancy. Intramuscular administration of a single dose of methotrexate (50 mg/m2) was performed to measure predictors of failure or resistance to treatment necessitating surgical intervention. During the time of treatment with a single dose of MTX, 20 patients (10.8%) failed to response, in which 6 of 20 (30%) indicated side effects to MTX and rupture of the ectopic pregnancy. Remaining cases () showed resistance to the drug; the level of β-hCG did not fall at least 15% during 7 days after treatment and necessitated laparotomy. In backward-step analysis by multiple logistic regressions of various types of predictor factors, size of gestational sac (coefficient = 1.91, OR = 6.78, 95% confidence interval = 3.18–8.22) and baseline level β-hCG (coefficient = 1.60, OR = 5.0, 95% confidence interval = 4.26–6.72) had significant correlation with leading EP patients failing to response to MTX. This study suggests that further investigation for finding relative contraindications of MTX treatment in EP women should be considered on the gestational sac size because other variables are in the causal pathway of this variable.

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Using a decline in serum hCG between days 0–4 to predict ectopic pregnancy treatment success after single-dose methotrexate: a retrospective cohort study

BMC Pregnancy and Childbirth ◽

10.1186/1471-2393-13-30 ◽

2013 ◽

Vol 13 (1) ◽

Cited By ~ 18

Author(s):

Monika Skubisz ◽

Philip Dutton ◽

William Colin Duncan ◽

Andrew W Horne ◽

Stephen Tong

Keyword(s):

Cohort Study ◽

Single Dose ◽

Ectopic Pregnancy ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Treatment Success ◽

Dose Methotrexate

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Risk Factors for Ectopic Pregnancy: A Multi-center Case Control Study

10.21203/rs.3.rs-136639/v1 ◽

2021 ◽

Author(s):

Nooria Atta ◽

Fahima Aram ◽

Nafisa Naseri ◽

Mahbooba Sahak

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Ectopic Pregnancy ◽

Case Control Study ◽

Case Control ◽

Pelvic Surgery ◽

Control Group ◽

Case Group ◽

History Of ◽

Control Study

Abstract Background: Ectopic pregnancy (EP) is defined as a pregnancy in which fertilized oocyte implants outside the endometrial cavity. Although there is no known etiology for ectopic pregnancy, some risk factors of EP have been determined. It has been evident that ectopic pregnancy can be of multifactorial origin. This multicenter research aims to study risk factors associated with increased risk of ectopic pregnancy in women living in Kabul. Methods: A multicenter case control study was conducted in five tertiary maternity hospitals located in Kabul, Afghanistan. A total of 457 pregnant women were included in this study. In the case group, women with diagnosed ectopic pregnancy, while in control group women with intrauterine pregnancy were included. For each case in this study, two controls were enrolled. Results: The mean (SD) age of women in case group was 27.9 (6) years while in control group it was 26.4 (5.5) years. This difference was not statistically significant. We found a significant association between history of abortion and EP (Adj. OR=1.57; 95%CI: 1.02, 2.42). Having history of abdominal/pelvic surgery was a risk factor for EP with adjusted OR 1.94 (95%CI: 1.15, 3.30). In this study we found an increasing risk of EP in women of 35 years or older compared to younger women (Crude OR=2.26; p= 0.024). In women reporting prior EP, the chance of its recurrence was increased (Crude OR= 9.64; 95%CI: 1.1, 83.2). No association of gravidity and parity was found with EP incidence. Conclusions: In this study we found a statistically significant association between history of abdominal/pelvic surgery and EP. In addition, history of abortion was suggested as a risk factor for ectopic pregnancy. In case of having a previous EP probability of its recurrence will be increased. Women with advanced age having other potential risk factors will be facing higher risk of EP.

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The effect of ultrasonography in predicting medical treatment success in ectopic pregnancy

Aegean Journal of Obstetrics and Gynecology ◽

10.46328/aejog.v1i1.13 ◽

2019 ◽

Vol 1 (1) ◽

pp. 5-7

Author(s):

Meric Balikoglu ◽

Burak Bayraktar ◽

Mert Mevlüt Akar

Keyword(s):

Single Dose ◽

Medical Treatment ◽

Ectopic Pregnancy ◽

Adnexal Mass ◽

Treatment Success ◽

Dose Methotrexate ◽

Treatment Prediction ◽

Significant Difference ◽

Mass Size ◽

The Right

Ectopic pregnancy(EP) treatment success in a single dose methotrexate(MTX) regimen is decided by more than 15% β chorionic gonadotropin reduction in the 4th and 7th days after administration of 50mg/m² of medication. In our study , it was aimed whether the EP mass size less than 40mm detected by ultrasonography and the adnexal side on which it was located had an effect on the success of medical treatment. 82 patients who treated with MTX included in the study were divided into two groups as those with a single dose of methotrexate success and those without (n:67 vs n:15). The groups were compared in terms of age, parity, size of adnexal mass detected on ultrasonography, and the side of ectopic pregnancy. The parity rates and the age of patients were similar in both groups(p = 0.615, p = 0.742). Although the average adnexal mass size was found to be higher in the patient group those single dose MTX treatment was not successful, there was no statistically significant difference(p = 0.098). Ectopic pregnancy was frequently observed on the right side in the group in which the medical treatment was successful(66 % vs 33%). The effect of ectopic pregnancy mass size on medical treatment prediction was investigated in cases with mass size less than 40mm. Ectopic pregnancy mass size, even if it is below 40 mm, may not indicate the medical treatment success.

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Spontaneous Heterotopic Pregnancy: Dual Case Report and Review of Literature

Case Reports in Obstetrics and Gynecology ◽

10.1155/2016/2145937 ◽

2016 ◽

Vol 2016 ◽

pp. 1-5 ◽

Cited By ~ 5

Author(s):

Annika Chadee ◽

Shadi Rezai ◽

Catherine Kirby ◽

Ekaterina Chadwick ◽

Sri Gottimukkala ◽

...

Keyword(s):

Risk Factors ◽

Ectopic Pregnancy ◽

Rare Complication ◽

Heterotopic Pregnancy ◽

Pelvic Surgery ◽

Intrauterine Pregnancy ◽

Fertility Treatments ◽

Populations At Risk ◽

History Of ◽

High Index Of Suspicion

Introduction.Heterotopic pregnancy is a rare complication usually seen in populations at risk for ectopic pregnancy or those undergoing fertility treatments. It is a potentially dangerous condition occurring in only 1 in 30,000 spontaneous pregnancies. With the advent of Assisted Reproduction Techniques (ART) and ovulation induction, the overall incidence of heterotopic pregnancy has risen to approximately 1 in 3,900 pregnancies. Other risk factors include a history of pelvic inflammatory disease (PID), tubal damage, pelvic surgery, uterine Mullerian abnormalities, and prior tubal surgery. Heterotopic pregnancy is a potentially fatal condition, rarely occurring in natural conception cycles. Most commonly, heterotopic pregnancy is diagnosed at the time of rupture when surgical management is required.Case.This paper represents two cases of heterotopic pregnancies as well as a literature review.Conclusion.Heterotopic pregnancy should be suspected in patients with an adnexal mass, even in the absence of risk factors. Clinicians must be alert to the fact that confirming an intrauterine pregnancy clinically or by ultrasound does not exclude the coexistence of an ectopic pregnancy. A high index of suspicion in women is needed for early and timely diagnosis, and management with laparotomy or laparoscopy can result in a favorable and successful obstetrical outcome.

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ECTOPIC PREGNANCY : A MAJOR CAUSE OF MATERNAL MORTALITY?

Journal of Nepal Medical Association ◽

10.31729/jnma.823 ◽

2003 ◽

Vol 42 (147) ◽

pp. 151-155

Author(s):

Rajshree Jha ◽

M Singh ◽

A Rana ◽

A Singh ◽

S Bastola

Keyword(s):

Risk Factors ◽

Ectopic Pregnancy ◽

Abnormal Uterine Bleeding ◽

Uterine Bleeding ◽

Pelvic Surgery ◽

Transvaginal Sonography ◽

Pregnancy Risk ◽

Abdominal Tenderness ◽

Presenting Symptoms ◽

History Of

ABSTRACTSeventyeight cases of ectopic pregnancy were studied retrospectively at Tribhuvan University TeachingHospital during April 1993 - December 1996. The overall incidence of etopic pregnancy was 0.86% livebirths. Grandmultipara were found to be at a low risk for ectopic pregnancy. A history of infertility andprevious pelvic surgery were positive risk factors. The most common presenting symptoms were abdominalpain (90%), history of amenorrhoea (46%), abnormal uterine bleeding (40%). On examination adenexaltenderness (72%), abdominal tenderness (68%), pallor (53%) and cervical excitation (33%) were the mostfrequent findings. Adenexal mass was noted in 22% cases and in 35 % cases the size of the uterus could notbe assessed. Ultrasonography and transvaginal sonography proved to be valuable diagnostic aids. Twomaternal deaths (2.6 %) due to ectopic pregnancy occurred in the hospital during this period.Key Words: Ectopic pregnancy, risk factors, sonography.

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Association of Risk Factors of Ectopic Pregnancy

The International Journal of Frontier Sciences ◽

10.37978/tijfs.v1i2.21 ◽

2017 ◽

Vol 1 (2) ◽

pp. 26-32

Author(s):

Dur e Shehwar ◽

Lubna Zubair

Keyword(s):

Risk Factors ◽

Ectopic Pregnancy ◽

Low Socioeconomic Status ◽

Uterine Cavity ◽

Pelvic Surgery ◽

Contraceptive Device ◽

Assisted Reproductive Technique ◽

History Of ◽

Tubal Disease ◽

Reproductive Technique

Abstract:Background: Ectopic pregnancy is the implantation of a fertilized ovum anywhere outside the uterine cavity. Around 95% of ectopic pregnancies occur in the Fallopian tubes. Most of these are occurring in the ampulla region. Other sites include the interstitial or the corneal region of the myometrium, cervix, ovary, peritoneal cavity (abdominal pregnancy) and in caesarean section scars. The objective of this study was to see the association of different risk factors of ectopic pregnancy.Methodology: It was a case-control study. The data was collected from Obstetrics & Gynaecology department Jinnah Hospital, Lahore and the study was completed at Gulab Devi PGMI, Lahore. For the analysis of data, SPSS version 16.00 was used.Results: 180 pregnant females were taken in which 90 were cases and 90 were controls. 16 females were more than 35 years in age of which 16% females had ectopic pregnancy. There were 3 females had history of smoking in which 3% females had ectopic pregnancy. There were 82 females who had history of pelvic surgery in which 43% female had ectopic pregnancy. There were 17 females have had history of previous ectopic pregnancy of which 14% were having ectopic pregnancy. There were 6 females have had history of IUCD (Intra uterine contraceptive device) of which 6% females were having ectopic pregnancy. There were 23 females who had history of PID (Pelvic inflammatory disease) of which 26% females were having ectopic pregnancy. There were 2 females have had history of tubal disease and had ectopic pregnancy. There were 21 females who had history of ART (Assisted reproductive technique) in which 3% females were presented with ectopic pregnancy. There was 1 female who had history of endometriosis in which 2% females were presented with ectopic pregnancy.There were 16 females have had history of low socioeconomic status of which 9% females were presented with ectopic pregnancy. There was 1 female who had history of tuberculosis and having ectopic pregnancy.Conclusion: In the present study age more than 35 years, smoking, previous ectopic pregnancy, insertion of IUCD, PID, assisted reproductive technique, tubal disease, history of pelvic surgery, endometriosis and tuberculosis had a great association with ectopic pregnancy.

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