High live birth rate after conservative treatment of ectopic pregnancy with Methotrexate

High live birth rate after conservative treatment of ectopic pregnancy with Methotrexate

Wysoka częstość żywych urodzeń po zachowawczym leczeniu ciąż ektopowych Metotreksatem

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Department of Gynecological EndocrinologyJagiellonian University Medical College, Krakow, Poland

Abstract

Objectives: The aim of the study was to assess fertility in patients diagnosed with ectopic pregnancy and treated with methotrexate, as well as safety and efficacy of conservative treatment. Also, risk factors of recurrent ectopic pregnancies were determined.

Material and methods: The study included 86 female patients with ectopic pregnancy, hospitalized and treated in the clinic of Gynecological Endocrinology, UJCM, Cracow, between 2007 and 2011. A total of 73 patients received a single dose of MTX in the amount of 50mg/m2 of body surface area. Serum b-hCG concentration was measured on days 4 and 7. The treatment was considered successful when b-hCG concentrations dropped to less than 0.2mIU/ml without surgery.

Results: Among 34 patients on follow-up, 8 (23.5%) did not attempt to conceive again, whereas 26 patients declared their wish to conceive again. The attempt proved to be successful in case of 16 women (61.53%), and they gave birth to healthy children. Average time to pregnancy was 14.9 months (SD±10.9). The first pregnancy occurred after 6 months and the last after 35 months. No congenital birth defects were found in the newborns.

Conclusions: Systemic, conservative treatment with methotrexate is an effective and safe way of managing ectopic pregnancy, even in cases with higher b-hCG concentrations. Most patients can be successfully treated without surgery, thus they may even be treated in outpatient settings. High fertility can be maintained and is independent of the skills of the operators and access to laparoscopic techniques. Conservative treatment does not increase the risk of recurrent ectopic pregnancy but should be offered in wards that provide 24-hour surgical care.

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Otrzymano: 20.05.2013

Zaakceptowano do druku: 30.10.2013 Corresponding author:

Jakub Wyroba

Department of Gynecological Endocrinology Jagiellonian University Medical College, Ul. Kopernika 23, 31-501 Kraków, Poland Tel 12-424-85-71; Fax. 12-424-85-70 email: kuba4u@gmail.com

Introduction

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Streszczenie

Cel pracy: Badanie miało na celu ocenę płodności pacjentek ze zdiagnozowaną ciążą pozamaciczną leczonych metotreksatem, skuteczność i bezpieczeństwo leczenia zachowawczego oraz poszukiwanie czynników ryzyka powtórnej ciąży pozamacicznej.

Materiał i metody: 86 pacjentek ze zdiagnozowaną ciążą pozamaciczną było objętych leczeniem w Klinice Endokrynologii Ginekologicznej UJCM w Krakowie od 2007 do 2011 roku. Po zakwalifikowaniu u 73 pacjentek zastosowano terapię pojedynczej dawki metotreksatu w ilości 50 mg/m² powierzchni ciała. Kolejno oceniano stężenia b-hCG w surowicy krwi w dniu czwartym i siódmym terapii. Za sukces terapeutyczny uznawano obniżenie wartości b-hCG poniżej 0,2 mIU/ml bez konieczności wykonania zabiegu operacyjnego.

Wyniki: Pośród 34 pacjentek z przebywających w opiece przyklinicznej, 8 (23,5%) nie zdecydowało się na kolejną ciążę. 26 pacjentek zdeklarowało plany reprodukcyjne, 16 (61,53%) z nich urodziło zdrowe dzieci. Średni czas do uzyskania ciąży wynosił 14,9 (SD 10,9) miesiąca. Pierwsza ciąża wystąpiła po 6 miesiącach a ostatnia obserwowana po 35 miesiącach. Nie zaobserwowano żadnych wad wrodzonych u urodzonych dzieci.

Wnioski: Systemowe leczenie zachowawcze metotreksatem jest terapią skuteczną i bezpieczną nawet przy wyższych wartościach b-hCG niż 3500 mIU/ml. Umożliwia wyleczenie większości pacjentek bez konieczności wykonywania zabiegu operacyjnego, nawet w trybie ambulatoryjnym. Pozwala na utrzymanie wysokiej płodności niezależnie od umiejętności operatora i dostępności technik laparoskopowych. Leczenie zachowawcze nie zwiększa ryzyka rozwoju ponownie ciąży pozamacicznej.

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It is also Yital to note that 07; theraS\ is the treatment oI choice in cases oI uniTue locali]ations oI an ectoSic SreJnanc\

such as cerYical anG uterine scar SreJnancies )inall\ in uncertain cases eIIort shoulG Ee unGertaNen to aYoiG ethical conseTuences oI the wronJ GiaJnosis anG Gecision

Conclusions

6\stemic conserYatiYe manaJement with methotre[ate is an eIIectiYe anG saIe Iorm oI treatinJ an ectoSic SreJnanc\ eYen in cases where Eh&* concentrations are Jreater than  mI8

ml 7he maMorit\ oI Satients can Ee successIull\ treateG without surJer\ anG thereIore ma\ eYen Ee treateG in outSatient settinJs

+iJh Iertilit\ inGeSenGent oI the sNills oI the oSerators anG access to laSaroscoSic techniTues can Ee maintaineG

&onserYatiYe treatment Goes not increase the risN oI GeYeloSinJ a recurrent ectoSic SreJnanc\ 7reatment shoulG Ee oIIereG in warGs that SroYiGe hour surJical care

Oświadczenie autorów

1. Jakub Wyroba – autor koncepcji i założeń pracy, przygotowanie manuskryptu i piśmiennictwa – autor zgłaszający i odpowiedzialny za manuskrypt.

2. Józef Krzysiek – autor założeń pracy, współautor protokołu, ostateczna weryfikacja i akceptacja manuskryptu.

3. Agnieszka Rajtar-Ciosek – opieka kliniczna, analiza statystyczna wyników, przygotowanie manuskryptu.

4. Olga Kacalska-Janssen – opracowanie koncepcji i założeń badań, opracowanie wyników badań, opieka kliniczna.

5. Andrzej Zmaczyński – analiza i interpretacja wyników, przygotowanie, korekta kształtu manuskryptu.

6. Joanna Wiatr – opracowanie wyników badań, przechowywanie dokumentacji.

7. Tomasz Milewicz – zebranie materiału, opieka kliniczna.

8. Magdalena Pulka – współautor tekstu pracy, korekta i aktualizacja literatury.

Źródło finansowania:

Praca nie była finansowana przez żadną instytucję naukowo-badawczą, stowarzyszenie ani inny podmiot, autorzy nie otrzymali żadnego grantu.

Konflikt interesów:

Autorzy nie zgłaszają konfliktu interesów oraz nie otrzymali żadnego wynagrodzenia związanego z powstawaniem pracy.

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