Document Detail


Randomized trial of conservative laparoscopic treatment and methotrexate administration in ectopic pregnancy and subsequent fertility.
MedLine Citation:
PMID:  9853887     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Methotrexate treatment was compared to laparoscopic salpingotomy for conservative management of ectopic pregnancy in a prospective randomized study. One hundred patients were randomized into two groups using random numbers. Inclusion criteria were an ectopic pregnancy visualized by ultrasound with a pre-therapeutic score <13 as assessed by the following six criteria, graded from 1 to 3: gestational age, human chorionic gonadotrophin (HCG) concentration, progesterone concentration, abdominal pain, haemoperitoneal volume and diameter of the haematosalpinx. The treatments were either 1 mg/kg of methotrexate injected transvaginally into the ectopic pregnancy without anaesthesia or administered i.m. when the pregnancy could not safely or easily be punctured (group 1), or laparoscopic salpingotomy (group 2). Success was defined as the return to normal (<10 mIU/ml) of HCG concentrations. Treatment was successful for 45 of 51 patients in group 1 (88.2%) and 47 of 49 in group 2 (95.9%). Medical treatment was significantly (P < 0.05) associated with shorter postoperative stay (24 compared with 46 h), but HCG returned to normal more quickly after laparoscopic treatment (13 compared with 29 days). Spontaneous reproductive performance was similar in both groups, but overall intrauterine pregnancy was higher, and repeat ectopic pregnancy lower, after methotrexate treatment. In selected cases of ectopic pregnancy, with a pre-therapeutic score <13, methotrexate treatment appeared as safe and efficient as conservative treatment by laparoscopy and was associated with improved subsequent fertility.
Authors:
H Fernandez; S C Yves Vincent; S Pauthier; F Audibert; R Frydman
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Human reproduction (Oxford, England)     Volume:  13     ISSN:  0268-1161     ISO Abbreviation:  Hum. Reprod.     Publication Date:  1998 Nov 
Date Detail:
Created Date:  1999-02-24     Completed Date:  1999-02-24     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8701199     Medline TA:  Hum Reprod     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  3239-43     Citation Subset:  IM    
Affiliation:
Department of Obstetrics and Gynecology, Antoine Béclère Hospital, Clamart, France.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Chorionic Gonadotropin / blood
Fallopian Tubes / surgery
Female
Fertility*
Humans
Laparoscopy* / adverse effects
Methotrexate / administration & dosage,  adverse effects,  therapeutic use*
Pregnancy
Pregnancy, Ectopic / drug therapy*,  surgery,  ultrasonography
Prospective Studies
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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