Association between response to the medical treatment and predicting factors in ectopic pregnancy

Authors

  • Sholeh Shahgheibi Professor, Infertility Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran
  • Saman Nasrollazadeh Student of Medicine, Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran
  • Nasrin Soufizadeh Assistant Professor, Infertility Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran
  • Mobin Naghshbandi Student of Medicine, Department of Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran

DOI:

https://doi.org/10.22122/cdj.v4i1.215

Keywords:

Ectopic Pregnancy, Pregnant Women, Methotrexate

Abstract

BACKGROUND: Ectopic pregnancy (EP) is the leading cause of maternal death in the first trimester of pregnancy. There are many variables which can predispose EP. The aim of this study was to evaluate the possible association between individual’s response to given medical treatment and predicting factors of ectopic pregnancy among pregnant women.

METHODS: In this cross-sectional study, 277 patients with ectopic pregnancy who were admitted to obstetrics and gynecology ward of Besat hospital, Sanandaj, Iran, were evaluated. The necessary information was obtained from all women diagnosed with EP during 2008 to 2013. Patients who received any medication before study or those who could not use methotrexate (MTX) were excluded from study.

RESULTS: In this study, 205 (74.1%) patients responded to the medical therapy. There was a significant association between successful response to the treatment and beta human chorionic gonadotropin (β-hCG) serum level less than 5000 mIU/ml, pregnancy sac size less than 4 cm and lack of fetal heart rate (FHR) in transvaginal sonography (TVS).

CONCLUSION: In conclusion, it was found that β-hCG serum level, pregnancy sac size and presence of FHR play a key role in predicting the response to the medical treatment in women with ectopic pregnancy, and might be helpful in selecting appropriate therapeutic scheme.

 

References

Rana P, Kazmi I, Singh R, Afzal M, Al-Abbasi FA, Aseeri A, et al. Ectopic pregnancy: A review. Arch Gynecol Obstet 2013; 288(4): 747-57.

Varma R, Gupta J. Tubal ectopic pregnancy. BMJ Clin Evid 2009; 2009.

Shaw JL, Dey SK, Critchley HO, Horne AW. Current knowledge of the aetiology of human tubal ectopic pregnancy. Hum Reprod Update 2010; 16(4): 432-44.

Bouyer J, Coste J, Fernandez H, Pouly JL, Job-Spira N. Sites of ectopic pregnancy: A 10- year population-based study of 1800 cases. Hum Reprod 2002; 17(12): 3224-30.

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(2): 192-203.

Barnhart KT, Fay CA, Suescum M, Sammel MD, Appleby D, Shaunik A, et al. Clinical factors affecting the accuracy of ultrasonography in symptomatic first-trimester pregnancy. Obstet Gynecol 2011; 117(2 Pt 1): 299-306.

Varma R, Mascarenhas L. Evidence-based management of ectopic pregnancy. Curr Obstet Gynaecol 2002; 12(4): 191-9.

Rodrigues SP, de Burlet KJ, Hiemstra E, Twijnstra AR, van Zwet EW, Trimbos-Kemper TC, et al. Ectopic pregnancy: When is expectant management safe? Gynecol Surg 2012; 9(4): 421-6.

van Mello NM, Mol F, Mol BW, Hajenius PJ. Conservative management of tubal ectopic pregnancy. Best Pract Res Clin Obstet Gynaecol 2009; 23(4): 509-18.

Raughley MJ, Frishman GN. Local treatment of ectopic pregnancy. Semin Reprod Med 2007; 25(2): 99-115.

Condous G, Okaro E, Khalid A, Lu C, Van Huffel S, Timmerman D, et al. A prospective evaluation of a single-visit strategy to manage pregnancies of unknown location. Hum Reprod 2005; 20(5): 1398-403.

Sivalingam VN, Duncan WC, Kirk E, Shephard LA,

Horne AW.Diagnosis and management of ectopic pregnancy. J Fam Plann Reprod Health Care 2011; 37(4): 231-40.

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.

McFadden D. Conditional logit analysis of qualitative choice behavior. San Francisco, CA: University of California; 1974.

Hu Z, Lo CP. Modeling urban growth in Atlanta using logistic regression. Comput Environ Urban Syst 2007; 31(6): 667-88.

Diggle P, Heagerty P, Liang KY, Zeger S. Analysis of longitudinal data. Oxford, UK: OUP Oxford; 2013.

Kimiaei P, Khani Z, Marefian A, Gholampour GM, Salimnejad M. The importance of gestational sac size of ectopic pregnancy in response to single-dose methotrexate. ISRN Obstet Gynecol 2013; 2013: 269425.

Saadati N, Najafian M, Masihi S, Safiary S, Abedi P. Comparison of two different protocols of methotrexate therapy in medical management of ectopic pregnancy. Iran Red Crescent Med J 2015; 17(12): e20147.

Cho GJ, Lee SH, Shin JW, Lee NW, Kim T, Kim HJ, et al. Predictors of success of repeated injections of single-dose methotrexate regimen for tubal ectopic pregnancy. J Korean Med Sci 2006; 21(1): 86-9.

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.

Mirbolouk F, Yousefnezhad A, Ghanbari A. Predicting factors of medical treatment success with single dose methotrexate in tubal ectopic pregnancy: A retrospective study. Iran J Reprod Med 2015; 13(6): 351-4.

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.

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Published

2018-02-24

How to Cite

1.
Shahgheibi S, Nasrollazadeh S, Soufizadeh N, Naghshbandi M. Association between response to the medical treatment and predicting factors in ectopic pregnancy. Chron Dis J. 2018;4(1):7–12.

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Original Article(s)