Document Detail


Are serum human chorionic gonadotropin clearance curves of use in monitoring methotrexate treatment in cervical pregnancy?
MedLine Citation:
PMID:  9696237     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To describe the monitoring of an unsuccessful case of methotrexate treatment of cervical pregnancy. DESIGN: Case report. SETTING: University hospital. PATIENT(S): A 27-year-old woman, gravida 3, para 1, with a vital cervical pregnancy. INTERVENTION(S): Feticide and methotrexate administered both locally and systemically. MAIN OUTCOME MEASURE(S): Treatment success, defined as elimination of the cervical pregnancy with preservation of the uterus. RESULT(S): Despite reassuringly declining serum hCG concentrations, several episodes of severe vaginal bleeding demanded transfusions of 19 U of packed cells, two angiographic embolizations that were complicated by septicemia, and a balloon catheter tamponade followed by a third angiographic embolization. Ultimately, a hysterectomy was necessary because of uncontrollable vaginal bleeding. CONCLUSION(S): This case report shows that serum hCG monitoring was not helpful in the detection of impending treatment failure. Currently, no guidelines are available to clinicians for predicting treatment failure of methotrexate in patients with cervical pregnancy. Serum hCG clearance curves do enable the timely detection of inadequately declining serum hCG concentrations, for which additional methotrexate can be administered.
Authors:
P J Hajenius; D Roos; W M Ankum; F Van der Veen
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Fertility and sterility     Volume:  70     ISSN:  0015-0282     ISO Abbreviation:  Fertil. Steril.     Publication Date:  1998 Aug 
Date Detail:
Created Date:  1998-08-27     Completed Date:  1998-08-27     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0372772     Medline TA:  Fertil Steril     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  362-5     Citation Subset:  IM    
Affiliation:
Center for Reproductive Medicine, Academic Medical Center, University of Amsterdam, The Netherlands. p.hajenius@amc.uva.nl
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MeSH Terms
Descriptor/Qualifier:
Adult
Cervix Uteri*
Chorionic Gonadotropin / blood*
Drug Monitoring / methods*
Female
Humans
Metabolic Clearance Rate
Methotrexate / therapeutic use*
Pregnancy
Pregnancy, Ectopic / drug therapy*
Chemical
Reg. No./Substance:
0/Chorionic Gonadotropin; 59-05-2/Methotrexate

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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