scholarly journals Methotrexate in Unruptured Ectopic Pregnancy: Comparing the Single- and Double-dose Treatment

2018 ◽  
Vol 6 (3) ◽  
pp. 1
Author(s):  
Nazli Navali ◽  
Nasim Jabbari Asl ◽  
Sanaz Moosavi
Keyword(s):  
Single Dose ◽  
Ectopic Pregnancy ◽  
Success Rate ◽  
Dose Group ◽  
Treatment Success ◽  
The Other ◽  
Double Dose ◽  
Dose Treatment ◽  
Significant Difference ◽  
Β Hcg

Introduction: Ectopic pregnancy (EP) poses a great threat to pregnant women, and in case of misdiagnosis could lead to catastrophic death of the patients. EP patients tend to be treated with surgical or non-surgical treatments. One of the most common therapies in managing EP is Methotrexate (MTX), which the efficacy of its single- and double-dose treatments will be evaluated in this study. Methods: One-hundred and twenty patients with EP, diagnosed in AL-Zahra hospital in Tabriz, Iran, were involved in the study and were divided, randomly, into two groups of 60 (though 4 of the patients in the second group left the study due to discontent, afterwards). For the first group 50 milligrams (mg) of intramuscular (IM) single-dose MTX was prescribed, while for the second group two doses of 50 mg IM MTX were prescribed. The levels of β-hCG were evaluated before the treatment, in the fourth and seventh days, and second and fourth weeks after the treatment. In addition, sonographic findings, clinical symptoms before the treatment, and side effects after treatment were recorded. Results: Success rate for the single-dose group was 85%, while for the double-dose group was 94.6%. However, there was no statistically significant difference between two groups. In addition, there were no significant relations between 2 groups in endometrial thickness, presence of abdominal free fluid and gestational age with the success rate. Regardless, the initial level of β-hCG was an indicator of treatment success rate. In patients with double-dose MTX, required period of time for β-hCG levels to reduce down to zero was significantly lower than the other group. Cut-off point for success rate with single-dose MTX was 3350, with the sensitivity of 88.9% and specificity of 76.5% and for the other group it was 3894.5, with the sensitivity of 66.7% and specificity of 71.7%. Conclusion: No significant difference was observed between single- and double-dose MTX groups in treating EP. The initial levels of β-hCG and mass size were the only factors to predict the treatment success rate. Double-dose regimen lowered β-hCG down to zero earlier than single-dose. Based on Cut-off points, while the initial β-hCG level was below 3350, single-dose treatment was efficient, whereas, between 3350 and 3894.5, double-dose treatment

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

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.

scholarly journals Predictors and clinical features of methotrexate (MTX) therapy for ectopic pregnancy

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Jing Zhang ◽  
Yu Zhang ◽  
Lu Gan ◽  
Xiao-ying Liu ◽  
Shan-ping Du
Keyword(s):  
Treatment Group ◽  
Ectopic Pregnancy ◽  
Success Rate ◽  
Clinical Features ◽  
Successful Treatment ◽  
Treatment Success ◽  
Health Concern ◽  
Predictive Tool ◽  
Β Hcg ◽  
Ectopic Pregnancies

Abstract Background Ectopic pregnancy is a major life- and fertility-threatening women’s health concern. As a result of advances in examination technology, an increasing number of ectopic pregnancies can be diagnosed early and treated with medical methods instead of surgery. The aim of this study was to summarize the clinical features and identify the predictors of success of methotrexate (MTX) treatment of ectopic pregnancy. Methods This was a retrospective study of 238 ectopic pregnancies treated with MTX in the Department of Gynecology of Shaanxi Provincial People’s Hospital from January 2017 to December 2017. Results Patients were divided into two groups: the successful treatment group (n = 166) and the failed treatment group (n = 72). The overall success rate of MTX therapy for ectopic pregnancy was 69.75%. The mean initial beta-human chorionic gonadotropin (β-hCG) level was significantly lower in the successful treatment group than in the failed treatment group (2538.08 IU/L versus 3533.17 IU/L, P = 0.000). The treatment success rate of the group with an initial β-hCG concentration less than 4000 IU/L was significantly higher than that of the group with an initial β-hCG concentration greater than 4000 IU/L. However, the success rate of the group with an initial β-hCG concentration greater than 4000 IU/L was still relatively high (54.55%). β-hCG levels were significantly increased on the 4th day in the failed treatment group (P = 0.000). Compared to the initial β-hCG level, the day-4 β-hCG level increased by more than 8.21%, indicating that the treatment was effective. The diagnostic sensitivity was 88.6%, the specificity was 74.5%, and the area under the receiver operating characteristic (ROC) curve was 0.863 (95% confidence interval (CI): 0.805–0.920). Conclusions MTX therapy as a treatment option is safe and effective for asymptomatic, hemodynamically stable patients with ectopic pregnancies who are interested in conservative treatment, regardless of the serum β-hCG level or adnexal mass size. The change in the β-hCG level between the initial day and the 4th day is an effective and early predictive tool for the success of MTX therapy for ectopic pregnancy.

scholarly journals Predictors and clinical features of methotrexate (MTX) therapy for ectopic pregnancy

2020 ◽  
Author(s):  
Jing Zhang ◽  
Yu Zhang ◽  
Lu Gan ◽  
Xiao-ying Liu ◽  
Shan-ping Du
Keyword(s):  
Treatment Group ◽  
Ectopic Pregnancy ◽  
Success Rate ◽  
Clinical Features ◽  
Successful Treatment ◽  
Treatment Success ◽  
Health Concern ◽  
Predictive Tool ◽  
Β Hcg ◽  
Ectopic Pregnancies

Abstract Background: Ectopic pregnancy is a major life- and fertility-threatening women’s health concern. As a result of advances in examination technology, an increasing number of ectopic pregnancies can be diagnosed early and treated with medical methods instead of surgery. The aim of this study was to summarize the clinical features and identify the predictors of success of methotrexate (MTX) treatment of ectopic pregnancy. Methods: This was a retrospective study of 238 ectopic pregnancies treated with MTX in the Department of Gynecology of Shaanxi Provincial People's Hospital from January 2017 to December 2017. Results: Patients were divided into two groups: the successful treatment group (n=166) and the failed treatment group (n=72). The overall success rate of MTX therapy for ectopic pregnancy was 69.75%. The mean initial beta-human chorionic gonadotropin (β-hCG) level was significantly lower in the successful treatment group than in the failed treatment group (2538.08 IU/L versus 3533.17 IU/L, P=0.000). The treatment success rate of the group with an initial β-hCG concentration less than 4000 IU/L was significantly higher than that of the group with an initial β-hCG concentration greater than 4000 IU/L. However, the success rate of the group with an initial β-hCG concentration greater than 4000 IU/L was still relatively high (54.55%). β-hCG levels were significantly increased on the 4th day in the failed treatment group (P=0.000). Compared to the initial β-hCG level, the day-4 β-hCG level increased by more than 8.21%, indicating that the treatment was effective. The diagnostic sensitivity was 88.6%, the specificity was 74.5%, and the area under the receiver operating characteristic (ROC) curve was 0.863 (95% confidence interval (CI): 0.805-0.920). Conclusions: MTX therapy as a treatment option is safe and effective for asymptomatic, hemodynamically stable patients with ectopic pregnancies who are interested in conservative treatment, regardless of the serum β-hCG level or adnexal mass size. The change in the β-hCG level between the initial day and the 4th day is an effective and early predictive tool for the success of MTX therapy for ectopic pregnancy.

scholarly journals Predictors and clinical features of methotrexate (MTX) therapy for ectopic pregnancy

2019 ◽  
Author(s):  
Jing Zhang ◽  
Yu Zhang ◽  
Lu Gan ◽  
Xiao-ying Liu ◽  
Shan-ping Du
Keyword(s):  
Treatment Group ◽  
Ectopic Pregnancy ◽  
Success Rate ◽  
Clinical Features ◽  
Successful Treatment ◽  
Treatment Success ◽  
Predictive Tool ◽  
Success Predictors ◽  
Β Hcg ◽  
Ectopic Pregnancies

Abstract Objective: The aim of this study was to summarize clinical features and identify success predictors of methotrexate (MTX) treatment in ectopic pregnancy. Methods: Retrospective study of 213 ectopic pregnancies (EPs) treated with MTX in the Department of Gynecology of the Shaanxi Provincial People's Hospital from January 2017 to December 2017. Results: Patients were divided into two groups: the successful treatment group (n=166) and the failed treatment group (n=47). The overall success rate of MTX therapy for ectopic pregnancy was 77.93%, and the total cost of MTX therapy ($437.83) was far lower than that of surgical treatment (>$1459.45). The mean initial β-hCG level was significantly lower in the successful treatment group than in the failed treatment group (2538.08 mIU/mL versus 3195.91 mIU/mL, P=0.010). The treatment success rate of the group with an initial β-hCG concentration less than 4000 IU/L was significantly higher than that of the group with an initial β-hCG concentration greater than 4000 IU/L. However, the success rate of the group with an initial β-hCG concentration greater than 4000 IU/L was still relatively high (61.22%). The β-hCG levels were significantly increased on the 4th day in the failed treatment group (P=0.000). Compared to the initial β-hCG level, the day-4 β-hCG level increased by more than 8.21%, indicating that the treatment was effective. The diagnostic sensitivity was 88.6%, the specificity was 74.5%, and the area under the ROC curve was 0.863 (95% CI: 0.805-0.920). Conclusions: MTX therapy as a treatment option is safe, effective and economical for asymptomatic, hemodynamically stable patients with EPs who are keen on fertility preservation, regardless of the serum β-hCG level or adnexal mass size. The change in the β-hCG level between the initial day and the 4th day is an effective and early predictive tool for the MTX therapy of ectopic pregnancy.

scholarly journals A novel approach in non-surgical management of tubal ectopic: combination of minimally invasive technique under ultrasound guidance with systemic methotrexate based on initial beta-HCG levels

2021 ◽  
Author(s):  
Mayoukh Kumar Chakraborty ◽  
Shalini Gainder ◽  
Subhas Chandra Saha ◽  
Rashmi Bagga
Keyword(s):  
Single Dose ◽  
Ectopic Pregnancy ◽  
Success Rate ◽  
Surgical Management ◽  
Dose Regimen ◽  
Ultrasound Guided ◽  
Group 3 ◽  
Group 2 ◽  
Β Hcg ◽  
Group 1

Background: Single dose methotrexate is the most preferred method of non-surgical management of unruptured tubal ectopic. A 2-dose regimen is suggested to treat tubal ectopic with higher trophoblastic cell load. Minimally invasive technique of ultrasound guided intracardiac KCL instillation along with systemic methotrexate has been in use even for live ectopic pregnancy. Objective of the study was to evaluate the success rate of single dose regimen of MTX (Methotrexate), 2-dose regimen of MTX and ultrasound guided instillation of intracardiac KCl in three different cohort of unruptured tubal ectopic pregnancy with an attempt to increase success of non-surgical management.Methods: Fifty-eight women with unruptured tubal ectopic pregnancy were assigned to treatment protocols according to the initial β-HCG levels and presence/absence of FCA (fetal cardiac activity). Group 1: presence of FCA in the tubal ectopic; Group 2: initial β-HCG ≤5000 IU/ml; Group 3:  initial β-HCG ≥5000 IU/ml without FCA. Women in group 1 were treated with ultrasound guided instillation of intracardiac KCl combined with systemic MTX. While women in group 2 were administered single dose regimen of MTX and group 3 received 2-dose regimen of MTX.Results: Overall success rate of non-surgical management was 89.3% across all groups. Success rate in Group 1 was 78.6%. Success rate was 93.1% in group 2 while 92.3% in group 3. Rupture rate was 1.7% in the present study.Conclusions: For non-surgical management categorizing and treating is an option with good result. Women with presence of cardiac activity can opt for non-surgical option with likely resolution in 78% cases.

scholarly journals Predictors and clinical features of methotrexate (MTX) therapy for ectopic pregnancy

2020 ◽  
Author(s):  
Jing Zhang ◽  
Yu Zhang ◽  
Lu Gan ◽  
Xiao-ying Liu ◽  
Shan-ping Du
Keyword(s):  
Treatment Group ◽  
Ectopic Pregnancy ◽  
Success Rate ◽  
Clinical Features ◽  
Successful Treatment ◽  
Treatment Success ◽  
Predictive Tool ◽  
Major Life ◽  
Β Hcg ◽  
Ectopic Pregnancies

Abstract Background: Ectopic pregnancy is a major life- and fertility-threatening concern in women’s health. As a result of advances in examination technology, an increasing number of ectopic pregnancies can be diagnosed early and treated with medical methods instead of surgery. The aim of this study was to summarize the clinical features and identify the predictors of success of methotrexate (MTX) treatment of ectopic pregnancy.Methods: This was a retrospective study of 238 ectopic pregnancies treated with MTX in the Department of Gynecology of Shaanxi Provincial People's Hospital from January 2017 to December 2017.Results: Patients were divided into two groups: the successful treatment group (n=166) and the failed treatment group (n=72). The overall success rate of MTX therapy for ectopic pregnancy was 69.75%. The mean initial β-hCG level was significantly lower in the successful treatment group than in the failed treatment group (2538.08 IU/L versus 3533.17 IU/L, P=0.000). The treatment success rate of the group with an initial β-hCG concentration less than 4000 IU/L was significantly higher than that of the group with an initial β-hCG concentration greater than 4000 IU/L. However, the success rate of the group with an initial β-hCG concentration greater than 4000 IU/L was still relatively high (54.55%). β-hCG levels were significantly increased on the 4th day in the failed treatment group (P=0.000). Compared to the initial β-hCG level, the day-4 β-hCG level increased by more than 8.21%, indicating that the treatment was effective. The diagnostic sensitivity was 88.6%, the specificity was 74.5%, and the area under the ROC curve was 0.863 (95% CI: 0.805-0.920).Conclusions: MTX therapy as a treatment option is safe and effective for asymptomatic, hemodynamically stable patients with ectopic pregnancies who are interested in conservative treatment, regardless of the serum β-hCG level or adnexal mass size. The change in the β-hCG level between the initial day and the 4th day is an effective and early predictive tool for the success of MTX therapy of ectopic pregnancy.

scholarly journals Predictors and clinical features of methotrexate (MTX) therapy for ectopic pregnancy

2020 ◽  
Author(s):  
Jing Zhang ◽  
Yu Zhang ◽  
Lu Gan ◽  
Xiao-ying Liu ◽  
Shan-ping Du
Keyword(s):  
Treatment Group ◽  
Ectopic Pregnancy ◽  
Success Rate ◽  
Clinical Features ◽  
Successful Treatment ◽  
Treatment Success ◽  
Predictive Tool ◽  
Major Life ◽  
Β Hcg ◽  
Ectopic Pregnancies

Abstract Background: Ectopic pregnancy is a major life- and fertility-threatening concern in women’s health. As a result of advances in examination technology, an increasing number of ectopic pregnancies can be diagnosed early and treated with medical methods instead of surgery. The aim of this study was to summarize the clinical features and identify the predictors of success of methotrexate (MTX) treatment of ectopic pregnancy. Methods: This was a retrospective study of 238 ectopic pregnancies treated with MTX in the Department of Gynecology of Shaanxi Provincial People's Hospital from January 2017 to December 2017. Results: Patients were divided into two groups: the successful treatment group (n=166) and the failed treatment group (n=72). The overall success rate of MTX therapy for ectopic pregnancy was 69.75%. The mean initial β-hCG level was significantly lower in the successful treatment group than in the failed treatment group (2538.08 IU/L versus 3533.17 IU/L, P=0.000). The treatment success rate of the group with an initial β-hCG concentration less than 4000 IU/L was significantly higher than that of the group with an initial β-hCG concentration greater than 4000 IU/L. However, the success rate of the group with an initial β-hCG concentration greater than 4000 IU/L was still relatively high (54.55%). β-hCG levels were significantly increased on the 4th day in the failed treatment group (P=0.000). Compared to the initial β-hCG level, the day-4 β-hCG level increased by more than 8.21%, indicating that the treatment was effective. The diagnostic sensitivity was 88.6%, the specificity was 74.5%, and the area under the ROC curve was 0.863 (95% CI: 0.805-0.920). Conclusions: MTX therapy as a treatment option is safe and effective for asymptomatic, hemodynamically stable patients with ectopic pregnancies who are interested in conservative treatment, regardless of the serum β-hCG level or adnexal mass size. The change in the β-hCG level between the initial day and the 4th day is an effective and early predictive tool for the success of MTX therapy of ectopic pregnancy.

Evaluation of tubal patency using hysterosalpingo-contrast sonography (HyCoSy) following salpingostomy and medical treatment of tubal pregnancy

2021 ◽  
Vol 20 (4) ◽  
pp. 12-16
Author(s):  
Aml El-Shabrawy ◽  
◽  
Ahmed Elsheikh ◽  
Samy Gebreel ◽  
Mohammed Elsokkary ◽  
...  
Keyword(s):  
Medical Treatment ◽  
Ectopic Pregnancy ◽  
Success Rate ◽  
Fallopian Tube ◽  
Tubal Pregnancy ◽  
Tubal Patency ◽  
Group I ◽  
Case Series Study ◽  
Maternity Hospitals ◽  
Significant Difference

Objective. Ectopic pregnancy adversely affects the patency of the fallopian tube and consequently the future pregnancy. There are different options of conservative treatment of tubal pregnancy such as methotrexate and salpingostomy [1]. There is little information on the success rate of maintaining tubal patency after methotrexate and salpingostomy [2]. Therefore, the aim of this study is to evaluate the ipsilateral tubal patency using HyCoSy after treatment of tubal pregnancy with methotrexate therapy versus salpingostomy. Patients and methods. This was a case-series study conducted in Ain Shams and Al-Azhar University Maternity Hospitals to evaluate the ipsilateral tubal patency using hysterosalpingo-contrast sonography (HyC0Sy) following salpingostomy and medical treatment of tubal pregnancy. This study included patients who were admitted to Ain Shams and Al-Azhar University Maternity Hospitals for having tubal pregnancy and were treated either with methotrexate or salpingostomy over a 4-year period between January 2017 and December 2020. The patients seeking fertility were re-evaluated for fallopian tubes patency by hysterosalpingogram 3 months after discharge. The study included 2 groups of women: group I (n = 200): women who were treated with methotrexate, and group II (n = 140): women who underwent salpingostomy. Results. HSG was performed in 200 cases of patients with tubal pregnancy who were treated with methotrexate and 140 cases of patients who underwent salpingostomy. The patency of the ipsilateral tube was 85% after methotrexate treatment and 84.2% after salpingostomy. There was no statistically significant difference between the two groups. Conclusion. The findings suggest similar success rate in maintaining the patency of the fallopian tube with either methotrexate or salpingostomy. Key words: ectopic pregnancy, hysterosalpingography, methotrexate, infertility, salpingostomy

scholarly journals Regression of Schistosoma mansoni associated morbidity among Ugandan preschool children following praziquantel treatment: A randomised trial

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0259338
Author(s):  
Allen Nalugwa ◽  
Edridah Muheki Tukahebwa ◽  
Annette Olsen ◽  
Fred Nuwaha
Keyword(s):  
Single Dose ◽  
Preschool Children ◽  
Liver Fibrosis ◽  
Schistosoma Mansoni ◽  
Randomised Trial ◽  
Double Dose ◽  
Number Of Children ◽  
Praziquantel Treatment ◽  
Significant Difference ◽  
Liver Enlargement

Preschool children suffer from morbidity attributable to Schistosoma mansoni. We compared a single and double dose of praziquantel treatment on the regression of S. mansoni associated morbidity in children less than six years in Uganda. We measured the sizes of spleen and liver as well as liver fibrosis before treatment and 8 months after treatment among children who either received one dose (n = 201) or two doses (n = 184) of praziquantel (standard oral dose of 40 mg/kg body weight). Heamoglobin measurements were also taken. Overall, liver enlargement reduced from 52.2% (95% CI (Confidence interval) 45.1, 59.3) to 17.9% (95% CI 12.9, 23.9) with a single dose and from 48.4 (95% CI 40.9, 55.8) to 17.9% (95% CI 12.7, 24.3) with a double dose and there was no significant difference between the changes in proportion of children with enlarged liver between the two treatment groups. The proportion of children with enlarged spleen was not significantly reduced in the group treated with either one or two doses, 47.8% (95% CI 41.7, 54.9) to 45.3% (95% CI 38.3, 52.4) and 48.4% (95% CI 40.9,55.8) to 40.8% 95% CI 33.6, 48.2), respectively. Liver fibrosis detected among children getting single dose (n = 9) or double doses (n = 13) resolved after treatment with praziquantel. The number of children with low heamoglobin significantly reduced from 51.2% (95% CI 44.1, 58.3) to 0.5% (0.2, 0.8) and 61.4% (95% CI 53.9,68.5) to 1.1% (95% CI 0.1, 3.9) after single and double dose treatment, respectively. These results suggest that there is no evidence of a difference in effect between one dose of praziquantel and two doses in reversing morbidity attributable to S. mansoni among children less than six years of age.

Serum β-hCG levels post-treatment of ectopic pregnancy with a single dose of intramuscular methotrexate

2015 ◽  
Vol 55 (2) ◽  
pp. 181-184 ◽  
Author(s):  
Ignatius E. Hadinata ◽  
Lex W. Doyle ◽  
Derrick Thompson ◽  
Leslie Reti
Keyword(s):  
Single Dose ◽  
Ectopic Pregnancy ◽  
Post Treatment ◽  
Β Hcg
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