Document Detail


Systemic methotrexate treatment of interstitial pregnancy--magnetic resonance imaging (MRI) as a valuable tool for monitoring treatment.
MedLine Citation:
PMID:  11042907     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Interstitial pregnancy occurs in 2-4% of ectopic pregnancies and is defined as implantation of the trophoblast in the interstitial part of the tuba uterina. Therefore the term intramural pregnancy can also be found in the literature. In 20% of the cases that progress beyond 12 weeks of amenorrhea a potentially life-threatening rupture of the uterus occurs, leading to a maternal mortality rate of 2.5%. According to the literature until a few years ago diagnosis was mainly made intraoperatively, and resulted in cornual resection or hysterectomy per laparotomy. Better methods of diagnosis and treatment of interstitial pregnancy can help to decrease morbidity and mortality associated with this condition. PATIENTS: We describe two cases of interstitial pregnancies that were eventually diagnosed and also monitored by magnetic resonance imaging (MRI) after systemic methotrexate treatment. Both patients were uniparous and experienced their second spontaneous pregnancy. METHODS: Treatment consisted of four doses (50 mg/m2 body surface area) of systemic intramuscular methotrexate alternating with four doses (6 mg) of intramuscular folic acid. When beta-hCG levels were undetectable, MRI results were compared with pre-therapeutic MRI findings. RESULTS: In patients A and B, beta-hCG levels were undetectable 64 and 88 days after initiation of methotrexate treatment, while magnetic resonance imaging revealed nearly equally persisting interstitial pregnancies. They initially presented as hyperintense lesions with hypointense zones and changed into a hypointense lesion with a central hyperintense area for patient A, and a completely hyperintense lesion for patient B at the time of negative beta-hCG levels in follow-up MRI. CONCLUSION: Systemic methotrexate treatment with an intramuscular regimen is effective in the treatment of interstitial pregnancy. MRI has the ability of correct tissue differentiation and objective three-dimensional measuring of interstitial pregnancy. We therefore propose this imaging modality as a valuable tool for monitoring systemic methotrexate treatment of interstitial pregnancy that should be used additionally to beta-hCG clearance curves.
Authors:
E Kucera; T H Helbich; I Klem; B Schurz; G Sliutz; S Leodolter; E A Joura
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Wiener klinische Wochenschrift     Volume:  112     ISSN:  0043-5325     ISO Abbreviation:  Wien. Klin. Wochenschr.     Publication Date:  2000 Sep 
Date Detail:
Created Date:  2000-11-07     Completed Date:  2000-11-07     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  21620870R     Medline TA:  Wien Klin Wochenschr     Country:  AUSTRIA    
Other Details:
Languages:  eng     Pagination:  772-5     Citation Subset:  IM    
Affiliation:
Department of Gynecology and Obstetrics, University of Vienna, Austria. elisabeth.kucera@akh-wien.ac.at
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MeSH Terms
Descriptor/Qualifier:
Adult
Chorionic Gonadotropin, beta Subunit, Human / blood
Female
Folic Acid / administration & dosage,  therapeutic use
Gestational Age
Humans
Injections, Intramuscular
Magnetic Resonance Imaging*
Methotrexate / administration & dosage,  therapeutic use*
Monitoring, Physiologic
Nucleic Acid Synthesis Inhibitors / administration & dosage,  therapeutic use*
Pregnancy
Pregnancy, Tubal / diagnosis*,  drug therapy*
Chemical
Reg. No./Substance:
0/Chorionic Gonadotropin, beta Subunit, Human; 0/Nucleic Acid Synthesis Inhibitors; 59-05-2/Methotrexate; 59-30-3/Folic Acid

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