scholarly journals Medical management of ectopic pregnancy in a low resource setting: the role of methotrexate

2021 ◽  
Vol 10 (3) ◽  
pp. 879
Author(s):  
Simon Birame Ndour ◽  
Mamour Gueye ◽  
Abdoul Aziz Diouf ◽  
Moussa Diallo
Keyword(s):  
Developing Countries ◽  
Medical Treatment ◽  
Ectopic Pregnancy ◽  
Medical Management ◽  
University Hospital ◽  
Resource Setting ◽  
Low Resource Setting ◽  
Ectopic Pregnancies

Background: Medical treatment using methotrexate. However, its indications and the protocol of administration are still under discussion. Even if follow-up problems are often raised in developing countries, medical treatment of ectopic pregnancy remains a reasonable option that we practice and share our experience here.Methods: We performed a retrospective cohort study of patients managed for an unruptured ectopic pregnancy in two university hospital facilities in Dakar: the Centre Hospitalier National de Pikine and the Centre de Santé de Philipe Maguilen Senghor. The data of this study are spread over a period of 10 years, from 2010 and 2019. We planned to evaluate maternal age, parity, gestational age, diagnosis circumstances, medical management, monitoring, and outcome. A single dose protocol was used. Data extracted from the registries were transferred to Microsoft Excel 2019, Mac version and then moved to SPSS (Statistical Package for Social Sciences, 26.Results: Over ten years, we had registered 18 patients who had received medical treatment out of a total of 263 ectopic pregnancies treated in the two facilities, i.e., a frequency of 6.8%. The average age was 28.8 years. The average initial HCG level was 10,460 mIU/ml. Treatment succeeded in more than 6 out of 10 patients (61.1%). However, we noted 5 cases of failure that had secondarily benefited from salpingectomy by laparotomy.Conclusions: Methotrexate is now part of the therapeutic arsenal in the management of unruptured tubal ectopic pregnancies. However, in developing countries, particularly in Senegal, there is a reluctance to use this therapeutic method, which, however, when a personalized follow-up is carried out, is achievable with a success rate comparable to other therapeutic methods.

Role of vault cytology in follow-up of hysterectomized women: Results and inferences from a low resource setting

2013 ◽  
Vol 41 (9) ◽  
pp. 762-766 ◽  
Author(s):  
Sanjay Gupta ◽  
Pushpa Sodhani ◽  
Veena Singh ◽  
Ashok Sehgal
Keyword(s):  
Low Resource ◽  
Resource Setting ◽  
Low Resource Setting

scholarly journals Laparoscopic Management of Interstitial Ectopic Pregnancies

2014 ◽  
Vol 6 (3) ◽  
pp. 163-166
Author(s):  
Shyam V Desai ◽  
Gaurav S Desai ◽  
Jessi Levi
Keyword(s):  
Ectopic Pregnancy ◽  
Operative Time ◽  
Laparoscopic Management ◽  
Ectopic Gestation ◽  
Estimated Blood Loss ◽  
Laparoscopic Excision ◽  
Interstitial Ectopic Pregnancy ◽  
Ectopic Pregnancies

ABSTRACT This illustration describes the successful laparoscopic management of interstitial ectopic pregnancy. Three women underwent laparoscopic excision for interstitial ectopic gestation. Mean operative time was 49.4 ± 8.4 minutes (41- 69 mins). Estimated blood loss was 50 ± 4 ml. There were no intraoperative or postoperative complications. Duration of hospital stay was 24 ± 3 hours. All patients are doing well on follow-up. The authors demonstrate the role of laparoscopic excision and conclude that this technique, when performed by experienced surgeons, allows for improved dexterity and is a safe and effective method in the management of interstitial ectopic pregnancy. How to cite this article Desai GS, Levi J, Desai SV. Laparoscopic Management of Interstitial Ectopic Pregnancies. J South Asian Feder Obst Gynae 2014;6(3):163-166.

scholarly journals Prolapse of the urethral mucosa in a prepubertal Indian girl

2018 ◽  
Vol 7 (8) ◽  
pp. 3397
Author(s):  
Sabita Pulavarthi ◽  
Sharmila Vijayan
Keyword(s):  
Surgical Treatment ◽  
Medical Treatment ◽  
Medical Management ◽  
Mucosal Prolapse ◽  
Indian Girl ◽  
Primary Modality

Prolapse of urethral mucosa in prepubescent girls is an uncommon entity and most often seen among native Africans. Management of these cases is controversial. Some would adopt initial medical treatment and others prefer surgical treatment as primary modality with a very few recurrences. Though urethral mucosal prolapse has been managed successfully with surgery in many African girls, the role of medical management and its success cannot be overlooked. Authors present a case of urethral mucosal prolapse in a prepubescent Indian girl who was successfully treated with medical management with no recurrence on follow up.

scholarly journals Medical management of ectopic pregnancy

2020 ◽  
Vol 9 (9) ◽  
pp. 3809
Author(s):  
Tseten Zangmu Bhutia ◽  
Zigmee Dorjee Tamang ◽  
Goutam Giri
Keyword(s):  
Medical Treatment ◽  
Ectopic Pregnancy ◽  
Failure Rate ◽  
Medical Management ◽  
Treatment Options ◽  
First Trimester ◽  
Benign Condition ◽  
Β Hcg ◽  
Ectopic Pregnancies ◽  
Period Of Gestation

Background: Ectopic pregnancy is a commonest cause of maternal morbidity and mortality in the first trimester of pregnancy. Clinical presentation of ectopic pregnancy has changed from life threatening disease to a more benign condition for which nonsurgical treatment options are available with methotrexate administered systemically or locally. The study was done to evaluate the outcome of medical management of ectopic pregnancy with single regimen methotrexate.Methods: A cohort study was conducted over 18 months on 60 unruptured ectopic pregnancies who were treated with methotrexate injection.Results: Out of 60 unruptured ectopic pregnancies, 53 (88.3%) were successfully treated with methotrexate. Failure rate was 11.7% (7/60) patients who underwent laparotomy. Success of medical treatment was dependent on pretreatment β-hCG (≤4102.5 mIU/mL), period of gestation (≤5 weeks), size of gestational sac (≤3 cm) above which the failure rate increases. No correlation was seen between fall of β-hCG from day 4 to 7 and the success rate. Mean time to resolution of β-hCG seen was 4.3±1.25 weeks. Mean duration of hospital stay was 8.85±1.603 days. Single dose regimen of methotrexate was given to all patients and only 1/60 patients required second dose of methotrexate for suboptimal decrease of β-hCG.Conclusions: The result showed that pretreatment β-hCG level and period of gestation were good predictors for success of medical treatment.

scholarly journals Role of methotrexate in ectopic pregnancy

2020 ◽  
Vol 10 (1) ◽  
pp. 84
Author(s):  
Munjal J. Pandya ◽  
Neha V. Ninama ◽  
Chirag V. Thummar ◽  
Meet K. Patel
Keyword(s):  
Ectopic Pregnancy ◽  
Success Rate ◽  
Surgical Intervention ◽  
Cost Effective ◽  
First Trimester ◽  
Medical College ◽  
Beta Human Chorionic Gonadotropin ◽  
Ectopic Pregnancies

Background: Ectopic pregnancy is an acute emergency in obstetric if not timely diagnosed and timely treated. Ectopic pregnancy is leading cause of death in first trimester. Ectopic pregnancy can be managed surgically or medically. Medical management with Methotrexate administration avoids anesthesia in surgery, is cost effective and also offers success rate comparable to surgical management. Aim and objectives were to study the role of methotrexate in ectopic pregnancyMethods: This will be a retrospective observational study conducted in Obstetrics and Gynecology department of AMC MET medical college. Study group constitutes of 30 females with ectopic pregnancy. Preliminary blood investigations, ultrasonography and beta-human chorionic gonadotropin (b-hcg) level will be tested. Patients will be treated with single dose of methotrexate 50 mg/M2. Follow up b-hcg level will be done after 48 hours. Response and tolerance to methotrexate will be monitored.Results: The success rate of methotrexate therapy in our study was 83.33% (n=25) and 16.66% (n=5) required surgical intervention with tubal ruptured and abdominal pain.Conclusions: Methotrexate treatment of ectopic pregnancies is safe and effective with no major side effects. It has the advantage of tubal conservation and saves patients from surgical intervention.

scholarly journals Improving paper-based discharge process; a continuous full-cycle quality improvement project in low resource setting

F1000Research ◽  
2018 ◽  
Vol 7 ◽  
pp. 324
Author(s):  
Ihab B Abdalrahman ◽  
Mohammed Elsanousi Huzaifa Mohammed ◽  
Abdelmohaymin A Abdalla ◽  
Sulaf Ibrahim Abdelaziz ◽  
Aboaagla Abdalbagi Ali ◽  
...  
Keyword(s):  
Discharge Summary ◽  
University Hospital ◽  
Practical Training ◽  
Discharge Process ◽  
Improvement Project ◽  
Resource Setting ◽  
Low Resource Setting ◽  
The Moment

Background: The moment of hospital discharge is a time for vulnerability for many patients and might jeopardize their safety. We found that the current structure of the discharge card at Soba University Hospital (SUH) does not improve the quality of the discharge summary. This hinders the delivery of valid, relevant and adequate health information and can negatively affect outpatient care.   Methods: We implemented a new discharge card design with structured headings at the Department of Medicine at Soba University Hospital from the beginning of March to April 15th, 2017.  This was coupled with educational sessions highlighting the problems that might occur if there were gaps in patient transition from inpatient to outpatient. Results: There was a significant improvement in documentation of the majority (>90%) of the items, including name, age, source of admission treating doctor, diagnosis and medication, but there was a drop in documentation of comorbidities. We also noticed that the new discharge summary format significantly improved the documentation of the majority of the headings (all P values were <0.001), yet, there was a drop in documentation of comorbidities and dates for follow up. Conclusions: Recording of paper-based health records like discharge summaries could be substantially improved by use of well-structured formats and practical training sessions. Improvement is a dynamic process. Some gaps might appear during execution, these need monitoring and continuous improvement to establish sustainability.

scholarly journals SAT0267 ROLE OF AGGRESSIVE IMMUNOSUPPRESSION ON SUBGLOTTIC STENOSIS IN GRANULOMATOSIS WITH POLYANGIITIS: RETROSPECTIVE ANALYSIS OF A MONOCENTRIC COHORT

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1076.1-1077
Author(s):  
L. Moroni ◽  
L. Giudice ◽  
G. A. Ramirez ◽  
S. Sartorelli ◽  
A. Cariddi ◽  
...  
Keyword(s):  
Medical Treatment ◽  
Clinical Characteristics ◽  
Granulomatosis With Polyangiitis ◽  
Balloon Catheter ◽  
Subglottic Stenosis ◽  
Damage Accrual ◽  
The Mean ◽  
The One

Background:Subglottic stenosis (SGS) is defined as airway narrowing below the vocal cords and is a common and potentially life-threatening manifestation of Granulomatosis with Polyangiitis (GPA), with an estimated prevalence of 16-23% (1). Balloon catheter dilation is effective in GPA-related SGS, but relapses are frequent. Little is known about the role of immunosuppression in this setting.Objectives:to analyse the clinical characteristics of a monocentric GPA cohort, describe phenotype differences among patients with and without SGS and investigate the role of surgical and medical treatments on relapse risk and general outcome.Methods:Biopsy-proven patients with SGS were identified by review of medical charts among a cohort of patients with GPA, classified according to the algorithm of the European Medicine Agency (2). The clinical characteristics of patients with SGS were retrospectively collected over a median follow-up time of 15.9 years and compared to those of patients without SGS.Results:Fourteen patients with SGS-GPA were identified, with a female to male ratio of 1:1 and a prevalence of 29.2% among the cohort. The mean ± SD age at GPA onset was 30.8 ± 14.4 years, with a mean time from GPA diagnosis to SGS onset of 4.7 ± 4.2 years. ANCA were positive in 78.6% (54.0% anti-PR3, 18.1% anti-MPO and 27.9% IFI only). The mean Birmingham Vasculitis Activity Score (BVAS) at onset was 10.0 ± 5.6. The main clinical manifestations associated with SGS were crusty rhinitis (100%), sinusitis (78%), pulmonary disease (72.7%), otitis/mastoiditis (50%), glomerulonephritis (42.9%), orbital pseudotumor (28.6%). Six patients (42.9%) received medical treatment only, other six (42.9%) had one to three balloon dilations and two (14.2%) underwent four or more procedures. Eight patients had no SGS relapse (maximum one dilation) and they all received immunosuppression with rituximab (RTX), cyclophosphamide (CYC) or azathioprine (AZA). All patients who received no immunosuppression, methotrexate (MTX) or mycophenolate (MMF) had at least one relapse. Patients treated with MTX or MMF had a mean relapse-free survival of 13.1 months, which was comparable to the one of patients not receiving medical treatment (40.2 months; p=NS) and shorter than the one of patients receiving CYC or RTX (153.2 months; p=0.032). CYC use also inversely correlated with the number of surgical procedures (r=-0.691, p=0.006). Compared to patients without SGS (31 consecutive patients with at least 4 years of follow-up), patients with SGS-GPA had an earlier disease onset (mean age 30.8 vs 50.4 years; p<0.001), but with lower BVAS (mean 10.0 vs 15.3; p=0.013) and showed a higher prevalence of crusty rhinitis (100% vs 67.7%; p=0.019). No difference was observed in damage accrual over time between the two groups.Conclusion:Subglottic stenosis is highly prevalent in patients with GPA and may define a milder disease subset occurring more frequently in younger patients. MTX and MMF might be insufficient to prevent SGS relapses requiring balloon dilation. Aggressive immunosuppression (CYC or RTX) might have a non-redundant role in this setting and reduce the risk of relapses.References:[1]Quinn KA, et al. Subglottic stenosis and endobronchial disease in granulomatosis with polyangiitis. Rheumatology 2019; 58 (12), 2203-2211.[2]Watts R, et al. Development and validation of a consensus methodology for the classification of the ANCA associated vasculitides and polyarteritis nodosa for epidemiological studies. Ann Rheum Dis 2007; 66: 222-7.Disclosure of Interests:Luca Moroni: None declared, Laura Giudice: None declared, Giuseppe Alvise Ramirez: None declared, Silvia Sartorelli: None declared, adriana cariddi: None declared, Angelo Carretta: None declared, Enrica Bozzolo: None declared, Lorenzo Dagna Grant/research support from: The Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR) received unresctricted research/educational grants from Abbvie, Bristol-Myers Squibb, Celgene, Janssen, Merk Sharp & Dohme, Mundipharma Pharmaceuticals, Novartis, Pfizer, Roche, Sanofi-Genzyme, and SOBI., Consultant of: Prof Lorenzo Dagna received consultation honoraria from Abbvie, Amgen, Biogen, Bristol-Myers Squibb, Celltrion, Novartis, Pfizer, Roche, Sanofi-Genzyme, and SOBI.

scholarly journals Medical Management of Ectopic Pregnancy: An Observational Study

2016 ◽  
Vol 29 (1) ◽  
pp. 32-36
Author(s):  
Shahana Begum ◽  
Rowshan Akhtar
Keyword(s):  
Single Dose ◽  
Observational Study ◽  
Medical Treatment ◽  
Ectopic Pregnancy ◽  
Medical Management ◽  
Progesterone Level ◽  
Fertility Treatment ◽  
Intrauterine Pregnancy ◽  
College Hospital ◽  
Serum Progesterone

Objectives: The aim of this study was to explore the safety and efficacy of medical management of ectopic pregnancy.Materials and methods: This prospective observational study was conducted between February 2011 to August 2013 in Chittagong Medical College Hospital (CMCH) and in different private clinics of Chittagong city. Twenty-seven patients of ectopic pregnancy conceived by fertility treatment were recruited for medical treatment after proper evaluation. Ectopic pregnancy was diagnosed by serum ?-hCG and progesterone level but missing intrauterine pregnancy by transabdominal sonography (TAS). Serum ?-hCG was repeated after 48 hours to observe doubling of the level. If level was not doubled or increment was not at least 66% and serum progesterone level was less than 15ng/ml then it was considered as ectopic pregnancy. Patients were treated with Injection methotrexate 50 mg intramuscularly either by single dose or two doses. After 4 days of 1st injection ?-hCG was repeated and if level decreased > 15% then patients were assessed weekly till ?-hCG fell to <5lU/L. If drop was <15% after 4 days a second dose of methotrexate was given.Results: Overall success rate was 66.66% . Surgical intervention was needed in 22.22% patients. All patients were treated after hospitalization in CMCH and different private clinics of Chittagong. They got injection methotrexate, antibiotic, antispasmodic and analgesics for abdominal pain. Single dose cured 55.55% patients and 11.11% patients needed second dose, another 11.11% patients were misdiagnosed –later on they were diagnosed as intrauterine pregnancy and medical termination was done. Within one year of treatment 33.33% patients conceived again. There was no side effect or complications of the treatment.Conclusion: This small trial gave a good impression about medical treatment in selective cases. The efficacy should be assessed in a randomized clinical trial with a different set of populationBangladesh J Obstet Gynaecol, 2014; Vol. 29(1) : 32-36

scholarly journals Surgical intervention in ectopic pregnancies

2019 ◽  
Vol 26 (06) ◽  
Author(s):  
Fouzia Rasool Memon ◽  
Mini Poothavelil ◽  
Samreen Memon
Keyword(s):  
Ectopic Pregnancy ◽  
Surgical Management ◽  
Surgical Intervention ◽  
University Hospital ◽  
Time Interval ◽  
Presenting Symptoms ◽  
Beta Hcg ◽  
Ultrasound Findings ◽  
Ectopic Pregnancies ◽  
Study Setting

Objectives: To find out the negative laparoscopy rate for suspected ectopic pregnancy. Study Design: Retrospective cohort study. Setting: Electronic medical record databases in North Cumbria University Hospital, Carlisle, United Kingdom. Period: August 2014 to August 2018. Material and Methods: The data of total 150 laparoscopies performed for ectopic pregnancy management was collected for gestational age at presentation, symptoms, serial beta human chorionic gonadotrophic hormone (HCG) levels, ultrasound findings, time interval for diagnosis, time to surgery and histology. Results: One hundred and fifty patients (52 under 5 weeks and 98 over 5 weeks’ gestation) were incorporated into this study. The primary presenting symptoms were pain and vaginal bleeding. Suboptimal rise in serial beta HCG (performed 48 hours apart) was seen in 69 patients (46%) while other 81 patients (54%) had confirmed ectopic on USS and were offered surgical management after the scan. One hundred forty for women (96%) went for surgical management and one patient had conservative management as she was asymptomatic with low HCG(less than 1000IU) at the first visit and rapid drop in serial BHG results. Fifty three women (35%) had surgery on the same day when they had ectopic pregnancies seen on USS, 63 (42%) went to theatre for surgery between 0-6 days, while 34 patients (23%) had surgery between 7-14 days of USS. All women were operated through laparoscopic route and tubal ectopic pregnancies were confirmed at laparoscopy. There was no negative laparoscopy in our study period. Conclusion: Judicious and timely surgical intervention made it possible to treat every case through laparoscopic route with zero negative laparoscopy rate.

Evaluation of a simulation faculty training workshop in a low-resource setting: a qualitative study

2021 ◽  
pp. bmjstel-2020-000829
Author(s):  
Rajasri Rao Seethamraju ◽  
Kimberly Stone ◽  
Michael Shepherd
Keyword(s):  
Qualitative Study ◽  
Positive Impact ◽  
Faculty Training ◽  
Research Approach ◽  
Instructor Training ◽  
Low Resource ◽  
Resource Setting ◽  
Low Resource Setting ◽  
Kirkpatrick Model

IntroductionSimulation instructor training courses are infrequent in low-resource countries. PediSTARS India organisation has been conducting a Training of Trainers (TOT) workshop annually since 2014 and has trained 380 instructors in the last 6 years. The objective of this study is to evaluate this workshop using the basic Kirkpatrick model with a blended evaluation approach.MethodsA qualitative study design was used with purposive sampling from the 2018 workshop cohort. An initial online questionnaire gathered demographic and professional profile of participants. Semistructured interviews with those who consented explored their perceptions about the workshop and their experiences using simulation for training at their workplaces. The analysis was done based on a deductive research approach around the framework of the first three levels of the Kirkpatrick model.ResultsA total of 11 in-depth interviews were conducted. Participants reported long-term retention, translation and positive impact of the knowledge and skills gained at the TOT workshop. The results achieved saturation and underwent respondent validation.ConclusionThis study provides evidence to support simulation faculty training workshops as an effective educational intervention in promoting simulation-related workplace-based education and training among health practitioners and that follow-up activity may be useful in some cases. This is the first study of its kind in a low-resource setting, and supports similar simulation instructor training in these settings and provides a blueprint for such training. Follow-up studies are required to evaluate the longer term impact of this simulation instructor training.

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