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1- Department of Obstetrics and Gynecology, Yas Women General Hospital, Tehran University of Medical Sciences, Tehran, Iran
2- Department of Obstetrics and Gynecology, Yas Women General Hospital, Tehran University of Medical Sciences, Tehran, Iran , nanazimi@gmail.com
Abstract:   (74 Views)
Background & Objective:  Persistent ectopic pregnancy (PEP) occurs due to incomplete removal of trophoblastic tissue during tubal pregnancy surgery treatment. If PEP is not diagnosed and treated in time, it can have high mortality and morbidity. This study aimed to evaluate the efficacy of methotrexate (MTX) administration in the prevention of PEP after linear laparoscopic salpingostomy in tubal pregnancy.
Materials & Methods: This randomized clinical trial study was conducted on 140 subjects with a diagnosis of unruptured tubal pregnancy, who were randomly divided into intervention and control groups. While the intervention group underwent a prophylactic injection of 50 mg MTX, the control group did not receive any dose of MTX. PEP was considered if there was an increase in serum BHCG levels or a decrease of less than 20% in serum BHCG levels.
Results: There was no significant difference between the intervention and control groups in terms of baseline variables such as age, severity, parity, and gestational age. While in the intervention group only one patient (1.4%) had PEP, in the control group 11 (15.7%) patients had PEP (P=0.003).
Conclusion: MTX administration seems to be an effective method in preventing PEP after linear laparoscopic salpingostomy in tubular pregnancy.
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Systematic Review: Original Research | Subject: General Gynecology and Pelvic Floor,
Received: 2020/10/1 | Accepted: 2020/11/16 | Published: 2021/01/1

References
1. Alkatout I, Honemeyer U, Strauss A, Tinelli A, Malvasi A, Jonat W, Mettler L, Schollmeyer T. Clinical diagnosis and treatment of ectopic pregnancy. Obstet Gynecol Surv. 2013;68(8):571-81. [DOI:10.1097/OGX.0b013e31829cdbeb] [PMID]
2. Zou S, Li X, Feng Y, Sun S, Li J, Egecioglu E, Billig H, Shao R. Comparison of the diagnostic values of circulating steroid hormones, VEGF-A, PIGF, and ADAM12 in women with ectopic pregnancy. J Transl Med. 2013;11(1):44. [DOI:10.1186/1479-5876-11-44] [PMID] [PMCID]
3. Feng C, Chen ZY, Zhang J, Xu H, Zhang XM, Huang XF. Clinical utility of serum reproductive hormones for the early diagnosis of ectopic pregnancy in the first trimester. J Obstet Gynaecol Res. 2013;39(2):528-35. [DOI:10.1111/j.1447-0756.2012.02001.x] [PMID]
4. Wu G, Yang J, Xu W, Yin T, Zou Y, Wang Y. Serum beta human chorionic gonadotropin levels on day 12 after in vitro fertilization in predicting final type of clinical pregnancy. J Reported Med. 2014;59(3-4):161.
5. Seifer DB, Diamond MP, DeCherney AH. Persistent ectopic pregnancy. Obstet Gynecol Clin North Am. 1991;18(1):153-9.
6. Vermesh M, Silva PD, Rosen GF, Stein AL, Fossum GT, Sauer MV. Management of unruptured ectopic gestation by linear salpingostomy: a prospective, randomized clinical trial of laparoscopy versus laparotomy. Obstet Gynecol. 1989;73(3 Pt 1):400-4.
7. Murphy AA, Nager CW, Wujek JJ, Kettel LM, Torp VA, Chin HG. Operative laparoscopy versus laparotomy for the management of ectopic pregnancy: a prospective trial. Fertil Steril. 1992;57(6):1180-5. [DOI:10.1016/S0015-0282(16)55070-5]
8. Barnhart KT. Ectopic pregnancy. New England Journal of Medicine. 2009;361(4):379-87. [DOI:10.1056/NEJMcp0810384] [PMID]
9. Seifer DB, Gutmann JN, Grant WD, Kamps CA, DeCHERNEY AH. Comparison of persistent ectopic pregnancy after laparoscopic salpingostomy versus salpingostomy at laparotomy for ectopic pregnancy. Obstet Gynecol. 1993;81(3):378-82.
10. 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):851-2. [DOI:10.1016/S0015-0282(16)46349-1]
11. Ory SJ, Villanueva AL, Sand PK, Tamura RK. Conservative treatment of ectopic pregnancy with methotrexate. Am J Obstet Gynecol. 1986;154(6):1299-306. [DOI:10.1016/0002-9378(86)90716-7]
12. Graczykowski JW, Mishell Jr DR. Methotrexate prophylaxis for persistent ectopic pregnancy after conservative treatment by salpingostomy. Obstet Gynecol. 1997;89(1):118-22. [DOI:10.1016/S0029-7844(96)00370-5]
13. Parker J, Bisks A, Proietto AM. A systematic review of single‐dose intramuscular methotrexate for the treatment of ectopic pregnancy. Aust N Z Obstet Gynecol. 1998;38(2):145-50. [DOI:10.1111/j.1479-828X.1998.tb02988.x] [PMID]
14. Isaacs Jr JD, McGehee RP, Cowan BD. Life-threatening neutropenia following methotrexate treatment of ectopic pregnancy: a report of two cases. Obstet Gynecol. 1996;88(4):694-6. [DOI:10.1016/0029-7844(96)00252-9]
15. Pansky M, Bukovsky I, Golan A, Langer R, Schneider D, Arieli S, Caspi E. Local methotrexate injection: a nonsurgical treatment of ectopic pregnancy. Am J Obstet Gynecol. 1989;161(2):393-6. [DOI:10.1016/0002-9378(89)90529-2]
16. Akira S, Ishihara T, Yamanaka A, Takeshita T, Kaseki H, Araki T. Laparoscopy with ultrasonographic guidance of intraamniotic methotrexate injection for ectopic pregnancy. A report of two cases. J Reprod Med. 2000;45(10):844-6.
17. Ménard A, Créquat J, Mandelbrot L, Hauuy JP, Madelenat P. Treatment of unruptured tubal pregnancy by local injection of methotrexate under transvaginal sonographic control. Fertil Steril. 1990;54(1):47-50. [DOI:10.1016/S0015-0282(16)53635-8]
18. 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(4):773-7. [DOI:10.1016/S0015-0282(16)55858-0]
19. Robinson RD, Ginsburg ES. Persistent tubal pregnancy presenting with delayed hemorrhage from a second implantation of trophoblast on the ovary: a case report. The J Reprod Med. 2004;49(8):693-5.
20. Dumesic DA, Hafez GR. Delayed hemorrhage of a persistent ectopic pregnancy following laparoscopic salpingostomy and methotrexate therapy. Obstet Gynecol. 1991;78(5 Pt 2):960-2.
21. Akira S, Negishi Y, Abe T, Ichikawa M, Takeshita T. Prophylactic intratubal injection of methotrexate after linear salpingostomy for prevention of persistent ectopic pregnancy. J Obstet Gynaecol Res. 2008;34(5):885-9. [DOI:10.1111/j.1447-0756.2008.00746.x] [PMID]
22. Kaya H, Babar Y, Ozmen S, Ozkaya O, Karci M, Aydin AR, Ozbasar D. Intratubal methotrexate for prevention of persistent ectopic pregnancy after salpingotomy. The J Am Assoc Gynecol Laparosc. 2002 Nov 1;9(4):464-7. [DOI:10.1016/S1074-3804(05)60520-8]

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