Conservative treatment of intact ectopic pregnancy with methotrexate

Authors

DOI:

https://doi.org/10.33448/rsd-v11i10.33028

Keywords:

Pregnancy; Ectopic; Drug therapy.

Abstract

Introduction: Ectopic pregnancy (EP) is generally defined as the implantation of the blastocyst outside the uterine cavity, synonymous with extrauterine pregnancy. Objective: To analyze the effectiveness of conservative treatment with methotrexate (MTX) in intact EP. Methods: This is a systematic review carried out through extensive research in the medical literature using the electronic databases: Medline (PubMed) and LILACS, with the following search strategy: ("Pregnancy, Ectopic"[Majr] AND "Drug Therapy "[Mesh]). Results: The selected studies converge to demonstrate the effectiveness of conservative treatment with MTX in intact EP and were grouped into three main groups: Patients undergoing conservative treatment with MTX in the single-dose (SD) protocol, patients undergoing the double-dose (DD) protocol and patients undergoing conservative treatment who do not meet the protocol criteria for the use of MTX. The results showed that the MTX SD protocol has sufficient efficacy in the treatment of EP, but in patients outside the parameters required by the current protocol, treatment success increases with the use of the DD or multiple dose method. Conclusions: The SD protocol with the option to elaborate for a second dose in case of treatment failure may be the ideal treatment for intact EP.

References

Ahmed, M. R., Sayed Ahmed, W. A., & Mohamed, T. Y. (2020). Day 1 change in maternal serum β-HCG levels as an early predictor of successful medical therapy in ectopic pregnancies. The Journal of Maternal-Fetal & Neonatal Medicine, 33(14), 2403-2407.

Baker, M., & Cruz, J. (2020). Ectopic Pregnancy, Ultrasound 2020.

Bonin, L., Pedreiro, C., Moret, S., Chene, G., Gaucherand, P., & Lamblin, G. (2017). Predictive factors for the methotrexate treatment outcome in ectopic pregnancy: A comparative study of 400 cases. European Journal of Obstetrics & Gynecology and Reproductive Biology, 208, 23-30.

Brady, P. C. (2017). New evidence to guide ectopic pregnancy diagnosis and management. Obstetrical & Gynecological Survey, 72(10), 618-625.

Breeze, C. (2016). Early pregnancy bleeding. Australian Family Physician, 45(5), 283-286.

Celis, P., Fuentes, F., Migueles, D., & Doren, A. (2017). Tratamiento médico del embarazo ectópico no complicado; experiencia del hospital regional de talca. Revista chilena de obstetricia y ginecología, 82(1), 46-50.

Chávez Nativi, Á. L., & Majano de Cruz, L. M. (2016). Uso de metrotexato en el manejo medico de embarazo ectópico en el Hospital Primero de Mayo del Instituto Salvadoreño del Seguro Social de enero a junio 2014.

Helmy, S., Koch, M., Kölbl, H., Grohmann-Izay, B., Solomayer, E., & Bader, Y. (2015). Correlation of the volume of ectopic pregnancy and MTX therapy outcome: a retrospective cohort study. European Journal of Obstetrics & Gynecology and Reproductive Biology, 184, 108-111.

Hendriks, E., Rosenberg, R., & Prine, L. (2020). Ectopic pregnancy: diagnosis and management. American family physician, 101(10), 599-606.

Kim, J., Jung, Y. M., Lee, D. Y., & Jee, B. C. (2017). Pretreatment serum human chorionic gonadotropin cutoff value for medical treatment success with single-dose and multi-dose regimen of methotrexate in tubal ectopic pregnancy. Obstetrics & gynecology science, 60(1), 79-86.

Levin, G., Dior, U. P., Shushan, A., Gilad, R., Benshushan, A., & Rottenstreich, A. (2020). Success rate of methotrexate treatment for recurrent vs. primary ectopic pregnancy: a case-control study. Journal of Obstetrics and Gynaecology, 40(4), 507-511.

Mergenthal, M. C., Senapati, S., Zee, J., Allen-Taylor, L., Whittaker, P. G., Takacs, P., & Barnhart, K. T. (2016). Medical management of ectopic pregnancy with single-dose and 2-dose methotrexate protocols: human chorionic gonadotropin trends and patient outcomes. American journal of obstetrics and gynecology, 215(5), 590-e1.

Saadati, N., Najafian, M., Masihi, S., Safiary, S., & Abedi, P. (2015). Comparison of two different protocols of methotrexate therapy in medical management of ectopic pregnancy. Iranian Red Crescent Medical Journal, 17(12).

Schultheis, P., Montoya, M. N., Zhao, Q., Archer, J., Madden, T., & Peipert, J. F. (2021). Contraception and ectopic pregnancy risk: a prospective observational analysis. American Journal of Obstetrics & Gynecology, 224(2), 228-229.

Song, T., Kim, M. K., Kim, M. L., Jung, Y. W., Yun, B. S., & Seong, S. J. (2016). Single-dose versus two-dose administration of methotrexate for the treatment of ectopic pregnancy: a randomized controlled trial. Human Reproduction, 31(2), 332-338.

Tasgoz, F. N., Temur, M., Dundar, B., Kartal, E., & Ustunyurt, E. (2020). The role of day 0 and day 4 β-human chorionic gonadotropin values and initial ultrasound findings in predicting the success of methotrexate treatment in ectopic pregnancy. Ginekologia Polska, 91(7), 389-393.

Trajano, J. B., Monteiro, D. L. M., & Jesus, N. R. (2017). Protocolo 12 – Gravidez ectópica. Volume 1: Obstetrícia. Série Rotinas Hospitalares - Hospital Universitário Pedro Ernesto. (2ª ed.) EdUERJ.

Vergara, P., Sepúlveda, A., & Parra, M. (2019). Embarazo ectópico cervical y cicatriz de cesárea. Diagnóstico y manejo. Rev Hosp Clin Univ Chile, 30, 57-70.

Zhang, J., Zhang, Y., Gan, L., Liu, X. Y., & Du, S. P. (2020). Predictors and clinical features of methotrexate (MTX) therapy for ectopic pregnancy. BMC Pregnancy and Childbirth, 20(1), 1-9.

Published

08/08/2022

How to Cite

OLIVEIRA, I. A. de .; SOARES, L. C. .; MONTEIRO, D. L. M. . Conservative treatment of intact ectopic pregnancy with methotrexate . Research, Society and Development, [S. l.], v. 11, n. 10, p. e485111033028, 2022. DOI: 10.33448/rsd-v11i10.33028. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/33028. Acesso em: 23 nov. 2024.

Issue

Section

Review Article