Unruptured ectopic pregnancy - Diagnosis and treatment. State of art;Gravidez ectópica não rota - Diagnóstico e tratamento. Situação atual

Revista Brasileira de Ginecologia e Obstetricia

Volumn 30, Issue 3, 2008, Pages 149-154

  Elito Jr , Julio ^a,d   Montenegro, Nuno Aires Mota De Mendonça ^b,c   Costa Soares, Roberto D A ^a   Camano, Luiz ^a  

^a FEDERAL UNIVERSITY OF SÃO PAULO   (Brazil)

^b HOSPITAL DE SÃO JOÃO   (Portugal)

^c University of Porto   (Portugal)

^d Universidade Federal de São Paulo UNIFESP ^*  (Brazil)

Author keywords

Chorionic gonadotropin diagnostic use; Fertility; Methotrexate therapeutic use; Pregnancy, ectopic diagnosis; Pregnancy, ectopic durg therapy; Pregnancy, ectopic surgery; Pregnancy, ectopic therapy; Pregnancy, ectopic ultrasonography

Indexed keywords

ARTICLE; DECISION TREE; ECTOPIC PREGNANCY; FEMALE; HUMAN; PREGNANCY;

DECISION TREES; FEMALE; HUMANS; PREGNANCY; PREGNANCY, ECTOPIC;

EID: 45849101548     PISSN: 01007203     EISSN: None     Source Type: Journal    
DOI: 10.1590/S0100-72032008000300008     Document Type: Article

References (77)

1. Berg CJ, Chang J, Callaghan WM, Whitehead SJ. Pregnancy-related mortality in the United States, 1991-1997. Obstet Gynecol. 2003;101(2):289-96.
2. Ash A, Smith A, Maxwell D. Caesarean scar pregnancy. BJOG. 2007;114:253-63.
3. Loureiro T, Cunha M, Marques E, Araújo ML, Montenegro N, Laurini R, et al. Non-viable cervico-isthmic pregnancy: the importance of an accurate sonographic diagnosis to preserve fertility. Fetal Diagn Ther. 2003;18(5):289-91.
4. Ankum WM, Mol BW, Van der Veen F, Bossuyt PM. Risk factors for ectopic pregnancy: a meta-analysis. Fertil Steril. 1996;65(6):1093-9.
5. Saraiya M, Berg CJ, Kendrick JS, Strauss LT, Atrash HK, Ahn YW. Cigarette smoking as a risk factor for ectopic pregnancy. Am J Obstet Gynecol. 1998;178(3):493-8.
6. Butts S, Sammel M, Hummel A, Chittams J, Barnhart K. Risk factors and clinical features of recurrent ectopic pregnancy: a case control study. Fertil Steril. 2003;80(6):1340-4.
7. Stovall TG, Ling FW, Carson SA, Buster JE. Nonsurgical diagnosis and treatment of tubal pregnancy. Fertil Steril. 1990;54(3):537-8.
8. Barnhart K, Mennuti MT, Benjamin I, Jacobson S, Goodman D, Coutifaris C. Prompt diagnosis of ectopic pregnancy in an emergency department setting. Obstet Gynecol. 1994;84(6):1010-5.
9. Gracia CR, Barnhart KT. Diagnosing ectopic pregnancy: decision analysis comparing six strategies. Obstet Gynecol. 2001;97(3):464-70.
10. Fritz MA, Guo SM. Doubling time of human chorionic gonadotropin (hCG) in early normal pregnancy: relationship to hCG concentration and gestational age. Fertil Steril. 1987;47(4):584-9.
11. Timor-Tritsch IE, Yeh MN, Peisner DB, Lesser KB, Slavik TA. The use of transvaginal ultrasonography in the diagnosis of ectopic pregnancy. Am J Obstet Gynecol. 1989;161(1):157-61.
12. Romero R, Kadar N, Copel JA, Jeanty P, DeCherney AH, Hobbins JC. The value of serial human chorionic gonadotropin testing as a diagnostic tool in ectopic pregnancy. Am J Obstet Gynecol. 1986;155(2):392-4.
13. Kadar N, Romero R. Observations on the log human chorionic gonadotropin-time relationship in early pregnancy and its practical implications. Am J Obstet Gynecol. 1987;157(1):73-8.
14. Barnhart KT, Sammel MD, Rinaudo PF, Zhou L, Hummel AC, Guo W. Symptomatic patients with an early viable intrauterine pregnancy: hCG curves redefined. Obstet Gynecol. 2004;104(1):50-5.
15. Chung K, Sammel MD, Coutifaris C, Chalian R, Lin K, Castelbaum AJ, et al. Defining the rise of serum HCG in viable pregnancies achieved through use of IVF. Hum Reprod. 2006;21(3):823-8.
16. Kadar N, Freedman M, Zacher M. Further observations on the doubling time of human chorionic gonadotropin in early asymptomatic pregnancies. Fertil Steril. 1990;54(5):783-7.
17. Barnhart KT, Katz I, Hummel A, Gracia CR. Presumed diagnosis of ectopic pregnancy. Obstet Gynecol. 2002;100(3):505-10.
18. Fernandez H, Gervaise A. Ectopic pregnancies after infertility treatment: modern diagnosis and therapeutic strategy. Hum Reprod Update. 2004;10(6):503-13.
19. Hajenius PJ, Mol F, Mol BW, Bossuyt PM, Ankum WM, van der Veen F. Interventions for tubal ectopic pregnancy. Cochrane Database Syst Rev. 2007;(1):CD000324.
20. Lundorff P, Thorburn J, Hahlin M, Källfelt B, Lindblom B. Laparoscopic surgery in ectopic pregnancy. A randomized trial versus laparotomy. Acta Obstet Gynecol Scand. 1991;70(4-5):343-8.
21. Silva PD, Schaper AM, Rooney B. Reproductive outcome after 143 laparoscopic procedures for ectopic pregnancy. Obstet Gynecol. 1993;81(5 Pt 1):710-5.
22. Bangsgaard N, Lund CO, Ottesen B, Nilas L. Improved fertility following conservative surgical treatment of ectopic pregnancy. BJOG. 2003;110(8):765-70.
23. Natale A, Candiani M, Merlo D, Izzo S, Gruft L, Busacca M. Human chorionic gonadotropin level as a predictor of trophoblastic infiltration into the tubal wall in ectopic pregnancy: a blinded study. Fertil Steril. 2003;79(4):981-6.
24. Cabar FR, Pereira PP, Schultz R, Zugaib M. Predictive factors of trophoblastic invasion into the ampullary region of the tubal wall in ectopic pregnancy. Hum Reprod. 2006;21(9):2426-31.
25. Elito Jr J, Han KK, Camano L. Values of beta-human chorionic gonadotropin as a risk factor for tubal obstruction after tubal pregnancy. Acta Obstet Gynecol Scand. 2005;84(9):864-7.
26. Lund CO, Nilas L, Bangsgaard N, Ottesen B. Persistent ectopic pregnancy after linear salpingotomy: a non-predictable complication to conservative surgery for tubal gestation. Acta Obstet Gynecol Scand. 2002;81(11):1053-9.
27. Lundorff P, Hahlin M, Sjöblom P, Lindblom B. Persistent trophoblast after conservative treatment of tubal pregnancy: prediction and detection. Obstet Gynecol. 1991;77(1):129-33.
28. Graczykowski JW, Mishell DR Jr. Methotrexate prophylaxis for persistent ectopic pregnancy after conservative treatment by salpingostomy. Obstet Gynecol. 1997;89(1):118-22.
29. Gracia CR, Brown HA, Barnhart KT. Prophylactic methotrexate after linear salpingostomy: a decision analysis. Fertil Steril. 2001;76(6):1191-5.
30. Clausen I. Conservative versus radical surgery for tubal pregnancy. A review. Acta Obstet Gynecol Scand. 1996;75(1):8-12.
31. Mol BW, Hajenius PJ, Ankum WM, van der Veen F, Bossuyt PM. Conservative versus radical surgery for tubal pregnancy. Acta Obstet Gynecol Scand. 1996;75(9):866-7.
32. Mol BW, Matthijsse HC, Tinga DJ, Huynh T, Hajenius PJ, Ankum WM, et al. Fertility after conservative and radical surgery for tubal pregnancy. Hum Reprod. 1998;13(7):1804-9.
33. Tanaka T, Hayashi H, Kutsuzawa T, Fujimoto S, Ichinoe K. Treatment of interstitial ectopic pregnancy with methotrexate: report of a successful case. Fertil Steril. 1982;37(6):851-5.
34. Ory SJ, Villanueva AL, Sand PK, Tamura RK. Conservative treatment of ectopic pregnancy with methotrexate. Am J Obstet Gynecol. 1986;154(6):1299-306.
35. Stovall TG, Ling FW, Buster JE. Outpatient chemotherapy of unruptured ectopic pregnancy. Fertil Steril. 1989;51(3):435-8.
36. Pisarska MD, Carson SA, Buster JE. Ectopic pregnancy. Lancet. 1998;351(9109):1115-20.
37. Lipscomb GH, Stovall TG, Ling FW. Nonsurgical treatment of ectopic pregnancy. N Engl J Med. 2000;343(18):13259.
38. Calabresi P, Chabner BA. Antineoplastic agents. In: Gilman A, Goodman LS, Goodman A, editors. The pharmacologic basis of therapeutics. 8th ed. New York: MacMillan; 1990. p. 1275-6.
39. Barnhart K, Coutifaris C, Esposito M. The pharmacology of methotrexate. Expert Opin Pharmacother. 2001;2(3):409-17.
40. Elito Jr J, Reichmann A, Uchiyama M, Camano L. Predictive score for the systemic treatment of unruptured ectopic pregnancy with a single dose of methotrexate. Int J Gynaecol Obstet. 1999;67(2):75-9.
41. Stovall TG, Ling FW, Gray LA. Single-dose methotrexate for treatment of ectopic pregnancy. Obstet Gynecol. 1991;77(5):754-7.
42. Lipscomb GH, Bran D, McCord ML, Portera JC, Ling FW. Analysis of three hundred fifteen ectopic pregnancies treated with single-dose methotrexate. Am J Obstet Gynecol. 1998;178(6):1354-8.
43. 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(4):778-84.
44. Elito Jr J, Han KK, Camano L. Tubal patency after clinical treatment of unruptured ectopic pregnancy. Int J Gynaecol Obstet. 2005;88(3):309-13.
45. Barnhart KT, Sammel MD, Hummel AC, Jain JK, Chakhtoura N, Strauss J. A novel "two dose" regimen of methotrexate to treat ectopic pregnancy. Fertil Steril. 2005;84 Suppl 1:S130-1.
46. Lipscomb GH, Puckett KJ, Bran D, Ling FW. Management of separation pain after single-dose methotrexate therapy for ectopic pregnancy. Obstet Gynecol. 1999;93(4):590-3.
47. Schoenfeld A, Mashiach R, Vardy M, Ovadia J. Methotrexate pneumonitis in nonsurgical treatment of ectopic pregnancy. Obstet Gynecol. 1992;80(3 Pt 2):520-1.
48. Isaacs JD Jr, McGehee RP, Cowan BD. Life-threatening neutropenia following methotrexate treatment of ectopic pregnancy: a report of two cases. Obstet Gynecol. 1996;88(4 Pt 2):694-6.
49. Dudley PS, Heard MJ, Sangi-Haghpeykar H, Carson SA, Buster JE. Characterizing ectopic pregnancies that rupture despite treatment with methotrexate. Fertil Steril. 2004;82(5):1374-8.
50. Atri M, Bret PM, Tulandi T, Senterman MK. Ectopic pregnancy: evolution after treatment with transvaginal methotrexate. Radiology. 1992;185(3):749-53.
51. Tawfiq A, Agameya AF, Claman P. Predictors of treatment failure for ectopic pregnancy treated with single-dose methotrexate. Fertil Steril. 2000;74(5):877-80.
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(5):1192-4.
53. Lipscomb GH, McCord ML, Stovall TG, Huff G, Portera SG, Ling FW. Predictors of success of methotrexate treatment in women with tubal ectopic pregnancies. N Engl J Med. 1999;341(26):1974-8.
54. Soares RC, Elito Jr J, Han KK, Camano L. Endometrial thickness as an orienting factor for the medical treatment of unruptured tubal pregnancy. Acta Scand Gynecol Obstet. 2004;83(3):289-92.
55. Elito Junior J, Uchiyama M, Camano L. O metotrexato no tratamento sistêmico da prenhez ectópica íntegra. Rev Bras Ginecol Obstet. 1996;18(7):537-41.
56. Elito Junior J, Uchiyama M, Camano L. Evolução dos níveis de beta-hCG após tratamento sistêmico da gravidez ectópica íntegra. Rev Assoc Med Bras. 1998;44(1):11-5.
57. Soares RC, Elito Junior J, Camano L. Increment in beta-hCG in the 48-h period prior to treatment: a new variable predictive of therapeutic success in the treatment of ectopic pregnancy with methotrexate. Arch Gynecol Obstet. In press 2008.
58. Soares RC, Elito Júnior J, Camano, L. Relação entre a espessura endometrial e os níveis de beta-hCG com a resposta ao tratamento da gravidez ectópica com metotrexato. Rev Bras Ginecol Obstet. 2004;26(6):471-5.
59. Soares RC, Elito Junior J, Han KK, Camano L. Espessura endometrial como fator orientador do tratamento clínico da gravidez tubária íntegra. Rev Bras Ginecol Obstet. 2002;24(5):309-13.
60. Elito Júnior J, Reichmann A, Uchiyama MN, Camano L. Ultrasonografia transvaginal com Doppler colorido para seleção das pacientes para tratamento conservador da gravidez ectópica íntegra. Rev Bras Ginecol Obstet. 1999;21(3):153-7.
61. Soares RC. Critérios de seleção para o tratamento clínico com metotrexato da gravidez ectópica [tese]. São Paulo: Universidade Federal de São Paulo; 2006.
62. Fernandez H, Pauthier S, Doumerc S, Lelaidier C, Olivennes F, Ville Y, et al. Ultrasound-guided injection of methotrexate versus laparoscopic salpingotomy in ectopic pregnancy. Fertil Steril. 1995;63(1):25-9.
63. Elito Júnior J, Uchiyama MN, Camano L. Gravidez ectópica cervical com embrião vivo: relato de 4 casos. Rev Bras Ginecol Obstet. 1999;21(6):347-50.
64. Cepni I, Ocal P, Erkan S, Erzik B. Conservative treatment of cervical ectopic pregnancy with transvaginal ultrasound-guided aspiration and single-dose methotrexate. Fertil Steril. 2004;81(4):1130-2.
65. Jourdain O, Fontanges M, Schiano A, Rauch F, Gonnet JM. Management of other ectopic pregnancies (cornual, interstitial, angular, ovarian). J Gynecol Obstet Biol Reprod (Paris). 2003;32(7 Suppl):S93-100.
66. Barnhart K, Spandorfer S, Coutifaris C. Medical treatment of interstitial pregnancy. A report of three unsuccessful cases. J Reprod Med. 1997;42(8):521-4.
67. Tulandi T, Al-Jaroudi D. Interstitial pregnancy: results generated from the Society of Reproductive Surgeons Registry. Obstet Gynecol. 2004;103(1):47-50.
68. Ushakov FB, Elchalal U, Aceman PJ, Schenker JG. Cervical pregnancy: past and future. Obstet Gynecol Surv. 1997;52(1):45-59.
69. Lund JJ. Early ectopic pregnancy treated nonsurgically. J Obstet Gynaecol Br Emp. 1955;62:70-6.
70. Han KK, Elito Júnior J, Camano L. Conduta expectante para gravidez tubária íntegra. Rev Bras Ginecol Obstet. 1999;21(8):465-70.
71. Elito Junior J, Han KK, Camano L. Tubal patency following surgical and clinical treatment of ectopic pregnancy. São Paulo Med J. 2006;124(5):264-6.
72. Elito Junior J, Camano L. Unruptured tubal pregnancy: different treatments for early and late diagnosis. São Paulo Med J. 2006;124(6):321-4.
73. Seror V, Gelfucci F, Gerbaud L, Pouly JL, Fernandez H, Job-Spira N, et al. Care pathways for ectopic pregnancy: a population-based cost-effectiveness analysis. Fertil Steril. 2007;87(4):737-48.
74. Morlock RJ, Lafata JE, Eisenstein D. Cost-effectiveness of single-dose methotrexate compared with laparoscopic treatment of ectopic pregnancy. Obstet Gynecol. 2000;95(3):407-12.
75. 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(2):204-12.
76. Mota R, Gomes F, Ayres-de-Campo D. Medical treatment of nonruptured ectopic pregnancy using "single-dose" methotrexate: a 5 years experience. Acta Obstet Ginecol Port. 2007;1(1):5-9.
77. The Practice Committee of the American Society for Reproductive Medicine. Medical treatment of ectopic pregnancy. Fertil Steril. 2006;86(5 Suppl):S96-S102.