Authors:
Fernandez H. Vincent SC-AY. Pauthier S. Audibert F. Frydman R.
Institution:
H. Fernandez, Department Obstetrics and Gynecology, Antoine Beclere Hospital,
157, Rue de la Forte de Trivaux, 92141 Clamart; France.
Title:
Randomized trial of conservative laparoscopic treatment and methotrexate administration in ectopic pregnancy and subsequent fertility. (1998 2469)
Source:
Human Reproduction. Vol 13(11) (pp239-3243), 1998.
Abstract:
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), or laparoscopic salpingotomy (group). Success was defined as the return to normal (< 10 mIU/ml) of HCG concentrations. Treatment was successful for 45 of 51 patients in group (88.2%) and 47 of 49 in group (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 pretherapeutic score< 13, methotrexate treatment appeared as safe and efficient as conservative treatment by laparoscopy and was associated with improved subsequent fertility.
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- 1 What is a miscarriage?
- 2 What are the different types of miscarriage?
- 3 How accurate are pregnancy tests?
- 4 What is a blighted ovum?
- 5 I have had a hydatidiform mole. What is this?
- 6 Why did I have a spontaneous miscarriage?
- 7 How frequently do miscarriages occur?
- 8 I am miscarrying. How should this be treated?
- 8a Can miscarriage result in anxiety and depression?
- 9 What is meant by recurrent miscarriage?
- 10 I have a problem with recurrent miscarriage. What is the chance of my next pregnancy being successful?
- Q 12.11 Recurrent Miscarriage I have miscarried again. Why does this keep happening?
- 12 What congenital problems might be associated with recurrent miscarriage and how could they be treated?
- 13 What traumatic conditions can cause recurrent miscarriage and how can they be treated?
- 14 Can infection cause recurrent miscarriage and would treatment help?
- 15 Could a metabolic disorder cause recurrent miscarriage?
- 16 Could a hormonal problem account for recurrent miscarriage and would hormone treatment help me?
- 17 Could an autoimmune problem cause recurrent miscarriage and how could this be treated?
- 18 Could a tumour cause recurrent miscarriage?
- 19 What degenerative processes may be associated with recurrent miscarriage?
- 20 After every miscarriage I become more depressed. Could this account for the problem?
- 21 Is it always possible to explain recurrent miscarriage?
- 22 I have a problem with recurrent miscarriage. What treatment is available to ensure that this does not happen again?
- 23 What is an ectopic pregnancy?
- 24 How frequently do ectopic pregnancies occur?
- 25 Why do ectopic pregnancies occur?
- 26 How can an ectopic pregnancy be diagnosed?
- 27 How can an ectopic pregnancy be treated?
- 28 Where can I obtain more information?
- 29 Support Groups.
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