| Ectopic pregnancy: challenging accepted management strategies. | |
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MedLine Citation:
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PMID: 19694686 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Ectopic pregnancy is still the number one cause of maternal deaths in early pregnancy. The diagnostic capabilities of transvaginal ultrasound to confirm an EP are well founded. In fact, ultrasound technology, particularly the introduction of high-resolution transvaginal probes, has been the driving force behind the revolutionary change towards conservative management strategies in ectopic pregnancy care. Clinically stable women, however, with a scan diagnosis of a tubal ectopic pregnancy still routinely undergo surgery or are given methotrexate (MTX) at presentation. Conservative management for ectopic pregnancy may be considered in the context of clinical stability. Reassessment at 48 h allows evaluation of the trophoblast activity or 'trophoblastic load'. Falling serum hCG levels at 48 h suggest that the ectopic trophoblast is resolving spontaneously and it may be possible to avoid methotrexate administration in this sub-group. Women with increasing serum hCG levels at 48 h, indicating the trophoblast is still active, should be targeted for methotrexate. By calculating the pre-treatment hCG ratio (hCG 48 h/hCG 0 h), it is possible to triage women with an ectopic pregnancy for conservative management. There are, however, no randomised data to support the use of MTX over expectant management. In this review, some of the current management strategies in ectopic pregnancy management will be challenged. |
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Authors:
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George Condous |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: The Australian & New Zealand journal of obstetrics & gynaecology Volume: 49 ISSN: 1479-828X ISO Abbreviation: - Publication Date: 2009 Aug |
Date Detail:
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Created Date: 2009-08-21 Completed Date: 2009-11-04 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0001027 Medline TA: Aust N Z J Obstet Gynaecol Country: Australia |
Other Details:
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Languages: eng Pagination: 346-51 Citation Subset: IM |
Affiliation:
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Acute Gynaecology, Early Pregnancy and Advanced Endosurgery Unit, Nepean Centre for Perinatal Care, Nepean Clinical School, University of Sydney, Nepean Hospital, Penrith, Sydney, New South Wales, Australia. gcondous@omnigynaecare.com.au |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Abortifacient Agents, Nonsteroidal
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therapeutic use Female Humans Methotrexate / therapeutic use Pregnancy Pregnancy, Ectopic / therapy*, ultrasonography Prenatal Care / methods Preoperative Care / methods Treatment Outcome |
| Chemical | |
Reg. No./Substance:
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0/Abortifacient Agents, Nonsteroidal; 59-05-2/Methotrexate |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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