Ectopic Pregnancy

Expectant management may be appropriate in ectopic pregnancy | 2 Minute Medicine

1. Approximately 40% of cases of ectopic pregnancy in hemodynamically stable women resolved on their own.

2. Among women whose β-hCG levels rose with serial measurement, treatment with methotrexate was effective but at lower rates than previously reported.

Study Rundown: Ectopic pregnancy is a medical emergency and, given the risk of rupture, is actively managed with either surgical or medical treatment at the time of diagnosis. In general, hemodynamically stable women with β-hCG levels 5,000 and no fetal cardiac activity are usually treated with a single or multi- dose regimen of methotrexate. Under the current guidelines, expectant management is recommended only for women with β-hCG ≤200 mIU/mL. In this study, investigators sought to evaluate rates of spontaneous resolution of ectopic pregnancy as well as success rates of methotrexate therapy among hemodynamically stable women who did not achieve spontaneous resolution of ectopic pregnancy with expectant management.

Authors found that with expectant management, many cases of ectopic pregnancy spontaneously resolved. For women whose β-hCG levels did not drop with expectant management, methotrexate was effective in terminating most pregnancies, but success rates were lower than previously reported. This finding suggests that when cases are treated initially with methotrexate, treatment success may be confounded by spontaneous resolution in some women. Additionally, because average β-hCG levels in many women were significantly greater than 200mIU/mL, the study results suggest that expectant management may be appropriate for more women than current guidelines suggest.

Limitations of this study include retrospective design and lack of a comparison group, which limit internal validity. Furthermore, it is unknown whether this study population comprised of Israeli women differed from that of previous investigations and whether results from the current investigation can be generalized to other populations. Randomized controlled trials are needed to determine whether expectant management yields decreased morbidity and comparable overall success rates.

In-Depth [retrospective cohort]: This study evaluated the success rate of expectant management of ectopic pregnancy in 1083 hemodynamically stable women and the success rate of methotrexate in women whose β-hCG did not spontaneously decline (n=409). Outcomes evaluated included spontaneous resolution, success with one or two doses of methotrexate and treatment failure.

In 39.5% of study participants, β-hCG spontaneously declined and patients required no further treatment. Among women requiring further intervention, 87% were successfully treated with methotrexate; 86% of these cases required only one injection. 13% of participants required surgical therapy. Women who were successfully treated with methotrexate had lower β-hCG levels than those eventually requiring surgery (p 0.0001).

More from this author: Decreased HIV co-receptor CCR5 expression after IUD insertion, Exercise associated with decreased Cesarean risk, Fetal reduction of triplets increases duration of gestation, Interpartum HIV viral load suppression improves outcomes, Low hCG in early pregnancy associated with preeclampsia

©2012-2014 All rights reserved. No works may be reproduced without expressed written consent from Disclaimer: We present factual information directly from peer reviewed medical journals. No post should be construed as medical advice and is not intended as such by the authors, editors, staff or by PLEASE SEE A HEALTHCARE PROVIDER IN YOUR AREA IF YOU SEEK MEDICAL ADVICE OF ANY SORT. TAGSectopic pregnancy SHARE Facebook Twitter 2 Minute Medicine’s The Classics in Medicine: Summaries of the Landmark Trials is available now in paperback and e-book editions. This text summarizes the key trials in: General Medicine and Chronic Disease, Cardiology, Critical and Emergent Care, Endocrinology, Gastroenterology, Hematology and Oncology, Imaging, Infectious Disease, Nephrology, Neurology, Pediatrics, Psychiatry, Pulmonology, and Surgery. Previous articleBath psoralen plus ultraviolet A shows good efficacy in the treatment of mycosis fungoidesNext articleThe NETT: Lung-volume-reduction surgery in emphysema Denise Pong, MPH RELATED ARTICLESMORE FROM AUTHOR Transvaginal ultrasound is the best diagnostic method for ectopic pregnancy NO COMMENTS Subscribe for Daily Reports

Popular The Child-Pugh score: Prognosis in chronic liver disease and cirrhosis [Classics... July 16, 2013 The CLOT trial: Dalteparin versus warfarin [Classics Series] December 7, 2014 Updated JNC 8 guidelines for antihypertensive drugs released December 19, 2013 Vaginal misoprostol improves ease of IUD insertion June 9, 2013 The NICE-SUGAR trial: Intensive glycemic control harmful in the ICU [Classics... January 1, 2013 ABOUT US2 Minute Medicine® is an award winning, physician-run, expert medical media company originally founded out of Harvard Medical School and the Massachusetts Institute of Technology. Our content is curated, written and edited by practicing health professionals who have clinical and scientific expertise in their field of reporting. Our editorial management team is comprised of highly-trained MD physicians. Join numerous brands, companies, and hospitals who trust our licensed content.Contact us: info@2minutemedicine.comFOLLOW US License Content Terms of Use | Disclaimer Log in Copyright 2 Minute Medicine, Inc. All rights reserved. MORE STORIES Transvaginal ultrasound is the best diagnostic method for ectopic pregnancy 2 Minute Medicine - April 24, 2013

Related Posts:

Ectopic pain vs. normal pregnancy cramps - April 2011 Babies -
A medical abortion at 6 weeks of pregnancy
5 Weeks Pregnant - What to Expect | Bounty
Ectopic Pregnancy | Symptoms and Treatment | BellyBelly
Symptoms of Miscarriage – Facts about Miscarriage