The non-surgical management of ectopic pregnancy

Ultrasound in Obstetrics and Gynecology

Volumn 27, Issue 1, 2006, Pages 91-100

  Kirk, E ^a   Condous, G ^a   Bourne, T ^a  

^a ST GEORGE'S UNIVERSITY OF LONDON   (United Kingdom)

Author keywords

Ectopic pregnancy; Expectant management; Methotrexate; Transvaginal ultrasound

Indexed keywords

CHORIONIC GONADOTROPIN; METHOTREXATE; PROGESTERONE;

ABDOMINAL PAIN; CLINICAL TRIAL; CONSERVATIVE TREATMENT; EARLY DIAGNOSIS; ECHOGRAPHY; ECTOPIC PREGNANCY; EXPECTANT MANAGEMENT; FATIGUE; GESTATION PERIOD; HEALTH CARE COST; HORMONE BLOOD LEVEL; HUMAN; NAUSEA; PREDICTION; PRIORITY JOURNAL; PROGESTERONE BLOOD LEVEL; REVIEW; SENSITIVITY AND SPECIFICITY; STOMACH DISEASE; TRANSVAGINAL ECHOGRAPHY;

ABORTIFACIENT AGENTS, NONSTEROIDAL; EARLY DIAGNOSIS; FEMALE; HUMANS; METHOTREXATE; PREGNANCY; PREGNANCY, ECTOPIC; PRENATAL CARE; ULTRASONOGRAPHY, PRENATAL;

EID: 31144473048     PISSN: 09607692     EISSN: 14690705     Source Type: Journal    
DOI: 10.1002/uog.2602     Document Type: Review

References (75)

1. 'Why Mothers Die', Triennial Report 2000-2002. Confidential Enquiry into Maternal Deaths, UK.
2. Cacciatore B, Stenman UH, Ylostalo P. Diagnosis of ectopic pregnancy by vaginal ultrasonography in combination with a discriminatory serum hCG level of 1000 IU/l (IRP). Br J Obstet Gynaecol 1990; 97: 904-908.
3. Condous G, Okaro E, Khalid A, Lu C, Van Huffel S, Bourne T. The accuracy of transvaginal ultrasonography for the diagnosis of ectopic pregnancy prior to surgery. Hum Reprod 2005; 20: 1404-1409.
4. Romero R, Kadar N, Jeanty P, Copel JA, Chervenak FA, DeCherney A, Hobbins JC. Diagnosis of ectopic pregnancy: value of the discriminatory human chorionic gonadotropin zone. Obstet Gynecol 1985; 66: 357-360.
5. Aleem FA, DeFazio M, Gintautas J. Endovaginal sonography for the early diagnosis of intrauterine and ectopic pregnancies. Hum Reprod 1990; 5: 755-758.
6. Valenzano M, Anserini P, Remorgida V, Brasca A, Centonze A, Costantini S. Transabdominal and transvaginal ultrasonographic diagnosis of ectopic pregnancy: clinical implications. Gynecol Obstet Invest 1991; 31: 8-11.
7. Goldstein S, Timor-Tritsch IE. Ultrasound in Gynecology. Churchill Livingstone: New York, 1995; 228.
8. Brown DL, Doubilet PM. Transvaginal sonography for diagnosing ectopic pregnancy: positivity criteria and performance characteristics. J Ultrasound Med 1994; 13: 259-266.
9. Stovall TG, Ling FW, Carson SA, Buster JE. Serum progesterone and uterine curettage in differential diagnosis of ectopic pregnancy. Fertil Steril 1992; 57: 456-458.
10. Stovall TG, Ling FW, Carson SA, Buster JE. Non-surgical diagnosis and treatment of tubal pregnancy. Fertil Steril 1990; 54: 537-548.
11. Elson J, Tailor A, Banerjee S, Salim R, Hillaby K, Jurkovic D. Expectant management of tubal ectopic pregnancy: prediction of successful outcome using decision tree analysis. Ultrasound Obstet Gynecol 2004; 23: 552-556.
12. Ylostalo P, Cacciatore B, Sjoberg J, Kaariainen M, Tenhunen A, Stenman UH. Expectant management of ectopic pregnancy. Obstet Gynecol 1992; 80: 345-348.
13. Korhonen J, Stenman UH, Ylostalo P. Serum human chorionic gonadotropin dynamics during spontaneous resolution of ectopic pregnancy. Fertil Steril 1994; 61: 632-636.
14. Cacciatore B, Korhonen J, Stenman UH, Ylostalo P. Transvaginal sonography and serum hCG in monitoring of presumed ectopic pregnancies selected for expectant management. Ultrasound Obstet Gynecol 1995; 5: 297-300.
15. Trio D, Strobelt N, Picciolo C, Lapinski RH, Ghidini A. Prognostic factors for successful expectant management of ectopic pregnancy. Fertil Steril 1995; 63: 469-472.
16. Shalev E, Peleg D, Tsabari A, Romano S, Bustan M. Spontaneous resolution of ectopic tubal pregnancy: natural history. Fertil Steril 1995; 63: 15-19.
17. Lui A, D'Ottavio G, Rustico MA, Conoscenti G, Fischer Tamaro F, Meir YJ, Maieron A, Mandruzzato GP. [Conservative management of ectopic pregnancy.] Minerva Ginecol 1997; 49: 67-72.
18. Olofsson JI, Poromaa IS, Ottander U, Kjellberg L, Damber MG. Clinical and pregnancy outcome following ectopic pregnancy; a prospective study comparing expectancy, surgery and systemic methotrexate treatment. Acta Obstet Gynecol Scand 2001; 80: 744-749.
19. Banerjee S, Aslam N, Woelfer B, Lawrence A, Elson J, Jurkovic D. Expectant management of early pregnancies of unknown location: a prospective evaluation of methods to predict spontaneous resolution of pregnancy. BJOG 2001; 108: 158-163.
20. Atri M, Chow CM, Kintzen G, Gillett P, Aldis AA, Thibodeau M, Reinhold C, Bret PM. Expectant treatment of ectopic pregnancies: clinical and sonographic predictors. AJR Am J Roentgenol 2001; 176: 123-127.
21. Rantala M, Makinen J. Tubal patency and fertility outcome after expectant management of ectopic pregnancy. Fertil Steril 1997; 68: 1043-1046.
22. Zohav E, Gemer O, Segal S. Reproductive outcome after expectant management of ectopic pregnancy. Eur J Obstet Gynecol Reprod Biol 1996; 66: 1-2.
23. Strobelt N, Mariani E, Ferrari L, Trio D, Tiezzi A, Ghidini A. Fertility after ectopic pregnancy. Effects of surgery and expectant management. J Reprod Med 2000; 45: 803-807.
24. Fernandez H, Lelaidier C, Baton C, Bourget P, Frydman R. Return of reproductive performance after expectant management and local treatment for ectopic pregnancy. Hum Reprod 1991; 6: 1474-1477.
25. Korhonen J, Stenman UH, Ylostalo P. Low-dose oral methotrexate with expectant management of ectopic pregnancy. Obstet Gynecol 1996; 88: 775-778.
26. Bernstein HB, Thrall MM, Clark WB. Expectant management of intramural ectopic pregnancy. Obstet Gynecol 2001; 97: 826-827.
27. Seow KM, Hsieh BC, Tsai YL, Huang LW, Hwang JL. Expectant management of a cornual pregnancy followed up by serial transvaginal color power Doppler angiography and serum beta human chorionic gonadotropin levels. Acta Obstet Gynecol Scand 2004; 83: 1221-1224.
28. Jermy K, Thomas J, Doo A, Bourne T. The conservative management of interstitial pregnancy. BJOG 2004; 111: 1283-1288.
29. Herman A, Weinraub Z, Avrech O, Maymon R, Ron-El R, Bukovsky Y. Follow up and outcome of isthmic pregnancy located in a previous Caesarean section scar. Br J Obstet Gynaecol 1995; 102: 839-841.
30. Jurkovic D, Hillaby K, Woelfer B, Lawrence A, Salim R, Elson CJ. First-trimester diagnosis and management of pregnancies implanted into the lower uterine segment Cesarean section scar. Ultrasound Obstet Gynecol 2003; 21: 220-227.
31. Jelsema RD, Zuidema L. First-trimester diagnosed cervicoisthmic pregnancy resulting in term delivery. Obstet Gynecol 1992; 80: 517-519.
32. Mesogitis SA, Daskalakis GJ, Doublis DG, Antsaklis AJ, Papantoniou NE, Michalas SP. Cervico-isthmic pregnancy: an extremely rare case diagnosed during labour. Eur J Obstet Gynecol Reprod Biol 2001; 98: 251-252.
33. Kirk E, Condous G, Khalid A, Haider Z, Bourne T. P04.13 Conservative management of cervical ectopic pregnancy. Ultrasound Obstet Gynecol 2004; 24: 291.
34. Stovall TG, Ling FW. Single dose methotrexate: an expanded clinical trial. Am J Obstet Gynecol 1993; 168: 1759-1765.
35. Erdem M, Erdem A, Arslan M, Oc A, Biberoglu K, Gursoy R. Single dose methotrexate for the treatment of unruptured ectopic pregnancy. Arch Gynecol Obstet 2004; 270: 201-204.
36. Glock JL, Johnson JV, Brumsted JR. Efficacy and safety of single-dose methotrexate in the treatment of ectopic pregnancy. Fertil Steril 1994; 62: 716-721.
37. Henry MA, Gentry WL. Single injection of methotrexate for treatment of ectopic pregnancies. Am J Obstet Gynecol 1994; 171: 1584-1587.
38. Ransom MX, Garcia AJ, Bohrer M, Corsan GH, Kemmann E. Serum progesterone as a predictor of success in the treatment of ectopic pregnancy. Obstet Gynecol 1994; 83: 1033-1037.
39. Corsan GH, Karacan M, Qasim S, Bohrer MK, Ransom MX, Kemmann E. Identification of hormonal parameters for successful systemic single-dose methotrexate therapy in ectopic pregnancy. Hum Reprod 1995; 10: 2719-2722.
40. Gross Z, Rodriguez JJ, Stalnaker BL. Ectopic pregnancy. Non-surgical, outpatient evaluation and single-dose methotrexate treatment. J Reprod Med 1995; 40: 371-374.
41. Stika CS, Anderson L, Frederiksen MC. Single-dose methotrexate for the treatment of ectopic pregnancy: Northwestern Memorial Hospital three-year experience. Am J Obstet Gynecol 1996; 174: 1840-1846.
42. Lecuru F, Robin F, Bernard JP, Maizan de Malartic C, MacCordick C, Boucaya V, Taurelle R. Single-dose methotrexate for unruptured ectopic pregnancy. Int J Gynaecol Obstet 1998; 61: 253-259.
43. Saraj AJ, Wilcox JG, Najmabadi S, Stein SM, Johnson MB, Paulson RJ. Resolution of hormonal markers of ectopic gestation: a randomized trial comparing single-dose intramuscular methotrexate with salpingostomy. Obstet Gynecol 1998; 92: 989-994.
44. Gazvani MR, Baruah DN, Alfirevic Z, Emery SJ. Mifeprostone in combination with methotrexate for the medical treatment of tubal pregnancy: a randomized, controlled trial. Hum Reprod 1998; 13: 1987-1990.
45. Thoen LD, Creinin MD. Medical treatment of ectopic pregnancy with methotrexate. Fertil Steril 1997; 68: 727-730.
46. Elito J Jr, Reichmann AP, Uchiyama MN, Camano L. Predictive score for the systemic treatment of unruptured ectopic pregnancy with a single dose of methotrexate. Int J Gynaecol Obstet 1999; 67: 75-79.
47. Tawfiq A, Agameya AF, Claman P. Predictors of treatment failure for ectopic pregnancy treated with single-dose methotrexate. Fertil Steril 2000; 74: 877-880.
48. Sowter MC, Farquhar CM, Petrie KJ, Gudex G. A randomised trial comparing single dose systemic methotrexate and laparoscopic surgery for the treatment of unruptured tubal pregnancy. BJOG 2001; 108: 192-203.
49. Lewis-Bliehall C, Rogers RG, Kammerer-Doak DN, Conway SC, Amaya C, Byrn F. Medical vs. surgical treatment of ectopic pregnancy. The University of New Mexico's six-year experience. J Reprod Med 2001; 46: 983-988.
50. el-Lamie IK, Shehata NA, Kamel HA. Intramuscular methotrexate for tubal pregnancy. J Reprod Med 2002; 47: 144-150.
51. Gamzu R, Almog B, Levin Y, Pauzner D, Lessing JB, Jaffa A, Bar-Am A. The ultrasonographic appearance of tubal pregnancy in patients treated with methotrexate. Hum Reprod 2002; 17: 2585-2587.
52. Potter MB, Lepine LA, Jamieson DJ. Predictors of success with methotrexate treatment of tubal ectopic pregnancy at Grady Memorial Hospital. Am J Obstet Gynecol 2003; 188: 1192-1194.
53. Alshimmiri MM, Al-Saleh EA, Al-Harmi JA, AlSalili MB, Adwani AA, Ibrahim ME. Treatment of ectopic pregnancy with a single intramuscular dose of methotrexate. Arch Gynecol Obstet 2003; 268: 181-183.
54. Lipscomb GH, Givens VA, Meyer NL, Bran D. Previous ectopic pregnancy as a predictor of failure of systemic methotrexate therapy. Fertil Steril 2004; 81: 1221-1224.
55. Kumtepe Y, Kadanali S. Medical treatment of ruptured with haemodynamically stable and unruptured ectopic pregnancy patients. Eur J Obstet Gynecol Reprod Biol 2004; 116: 221-225.
56. Lipscomb GH, Mc Cord ML, Stovall TG, Huff G, Portera SG, Ling F. Predictors of success of methotrexate treatment in women with ectopic pregnancies. N Engl J Med 1999; 341: 1974-1978.
57. Nazac A, Gervaise A, Bouyer J, de Tayrac R, Capella-Allouc S, Fernandez H. Predictors of success in methotrexate treatment of women with unruptured tubal pregnancies. Ultrasound Obstet Gynecol 2003; 21: 181-185.
58. Dudley PS, Heard MJ, Sangi-Haghpeykar H, Carson SA, Buster JE. Characterizing ectopic pregnancies that rupture despite treatment with methotrexate. Fertil Steril 2004; 82: 1374-1378.
59. Rozenberg P, Chevret S, Camus E, de Tayrac R, Garbin O, de Poncheville L, Coiffic J, Lucot JP, Le Goueff F, Tardif D, Allouche C, Fernandez H. GROG. Medical treatment of ectopic pregnancies: a randomized clinical trial comparing methotrexate-mifeprostone and methotrexate-placebo. Hum Reprod 2003; 18: 1802-1808.
60. Barnhart KT, Gosman G, Ashby R, Sammel M. The medical management of ectopic pregnancy: a meta-analysis comparing 'single dose' and 'multidose' regimens. Obstet Gynecol 2003; 101: 778-784.
61. Lipscomb GH, Meyer NL, Flynn DE, Peterson M, Ling FW. Oral methotrexate for treatment of ectopic pregnancy. Am J Obstet Gynecol 2002; 186: 1192-1195.
62. Periti E, Comparetto C, Villanucci A, Coccia ME, Tavella K, Amunni G. The use of intravenous methotrexate in the treatment of ectopic pregnancy. J Chemother 2004; 16: 211-215.
63. Tzafettas J, Anapliotis S, Zournatzi V, Boucklis A, Oxouzoglou N, Bondis J. Transvaginal intra-amniotic injection of methotrexate in early ectopic pregnancy. Advantages over the laparoscopic approach. Early Hum Dev 1994; 39: 101-107.
64. Fernandez H, Benifla JL, Lelaidier C, Baton C, Frydman R. Methotrexate treatment of ectopic pregnancy: 100 cases treated by primary transvaginal injection under sonographic control. Fertil Steril 1993; 59: 773-777.
65. Tolaymat LL, Brown TL, Maher JE, Horan CA, Green BA, Ripps BA. Reproductive potential after methotrexate treatment of ectopic gestation in a community hospital. J Reprod Med 1999; 44: 335-338.
66. Gervaise A, Mason L, de Tayrac R, Frydman R, Fernandez H. Reproductive outcome after methotrexate treatment of tubal pregnancies. Fertil Steril 2004; 82: 304-308.
67. Hajenius PJ, Engelsbel S, Mol BW, Van der Veen F, Ankum WM, Bossuyt PM, Hemrika DJ, Lammes FB. Randomised trial of systemic methotrexate versus laparoscopic salpingostomy in tubal pregnancy. Lancet 1997; 350: 774-779.
68. Fernandez H, Yves Vincent SC, Pauthier S, Audibert F, Frydman R. Randomized trial of conservative laparoscopic treatment and methotrexate administration in ectopic pregnancy and subsequent fertility. Hum Reprod 1998; 13: 3239-3243.
69. Mol BW, Hajenius PJ, Engelsbel S, Ankum WM, Hemrika DJ, Van der Veen F, Bossuyt PM. Treatment of tubal pregnancy in the Netherlands: an economic comparison of systemic methotrexate administration and laparoscopic salpingostomy. Am J Obstet Gynecol 1999; 181: 945-951.
70. Sowter MC, Farquhar CM, Gudex G. An economic evaluation of single dose systemic methotrexate and laparoscopic surgery for the treatment of unruptured ectopic pregnancy. BJOG 2001; 108: 204-212.
71. Celik C, Bala A, Acar A, Gezgine K, Akyurek C. Methotrexate for cervical pregnancy. A case report. J Reprod Med 2003; 48: 130-132.
72. Hung TH, Shau WY, Hsieh TT, Hsu JJ, Soong YK, Jeng CJ. Prognostic factors for an unsatisfactory primary methotrexate treatment of cervical pregnancy: a quantitative review. Hum Reprod 1998; 12: 2636-2642.
73. Clark SL, Koonings PP, Phelan JP. Placenta previa/accreta and prior Cesarean section. Obstet Gynecol 1985; 66: 89-92.
74. Condous G, Kirk E, Lu C, Van Huffel S, Gevaert O, De Moor B, De Smet F, Timmerman D, Bourne T. Diagnostic accuracy of varying discriminatory zones for the prediction of ectopic pregnancy in women with a pregnancy of unknown location. Ultrasound Obstet Gynecol 2005; (in press).
75. Condous G, Okaro E, Bourne T. The conservative management of early pregnancy complications: a review of the literature. Ultrasound Obstet Gynecol 2003; 22: 420-430.