The role of ultrasonography in methotrexate therapy for ectopic pregnancy

Methotrexate as the first-line treatment of unruptured tubular ectopic pregnancies with high initial human chorionic gonadotropin levels: A retrospective cohort

Objectives

To evaluate the effectiveness of the first-line medical management with Methotrexate (MTX) in the treatment of patients with stable tubal Ectopic Pregnancies (EPs) and varying ranges of Beta-Human Chorionic Gonadotropin (β-HCG) levels.

Materials and methods

In this retrospective cohort study, we reviewed the medical records of a total of 184 patients with the diagnosis of tubal EP, who received MTX as their first-line treatment. Patients with a baseline β-HCG< 4800 mIU/mL received single-dose MTX (n = 136) and those with an initial β-HCG≥ 4800 mIU/mL underwent the double-dose MTX regimen (n = 48). The treatment success was determined by evaluating the reported weekly β-HCG levels of the patients.

Results

Baseline β-HCG and mass size in the single-dose group were 1895.1 ± 1463.4 mIU/mL and 2.2 ± 1.1 cm, respectively, compared to 17,867.6 ± 31,870.5 mIU/mL and 2.3 ± 1.1 cm in the double-dose group. Treatment duration was 30.6 ± 16.9 days for single dose and 41.0 ± 27.0 days for double dose, with additional MTX in 27.2% and 12.5% in respective groups. Single dose achieved a 92.6% success rate, and double dose, 81.3%, without serious adverse effects. No significant effects were seen for either baseline β-HCG and mass size on the treatment success rates of both groups (p-value>0.05). However, the presence of Fetal Heart Rate (FHR) was associated with poorer responses only in the single-dose group (p-value=0.034).

Conclusions

Medical management with MTX shows promise as a first-line treatment for tubal EPs with β-HCG> 2000, suggesting a potential reassessment of existing guidelines in light of this emerging evidence. However, further research seems crucial in this field.

Socioeconomic Analysis of the Surgical Management of Ectopic Pregnancies: An Analysis of the National Inpatient Sample

STUDY OBJECTIVE

To identify racial and socioeconomic disparities in the surgical management of ectopic pregnancy DESIGN: The National Inpatient Sample (NIS) was sampled from 2015 to 2017 for inpatient hospitalizations for ectopic pregnancy. Cohorts were identified by surgical treatment type - open procedure versus laparoscopic procedure. Race/ethnicity, primary payer status, and median household income were primary variables of interest. Univariate and multivariable analysis was conducted.

DESIGN CLASSIFICATION

Retrospective SETTING: Nationwide inpatient analysis PATIENTS: Women presenting for ectopic pregnancy treatment INTERVENTIONS: Type of surgery MAIN OUTCOME MEASURES: Laparotomy versus laparoscopy for treatment MAIN RESULTS: A total of 18,725 cases were identified, 8,325 open and 10,400 laparoscopic. Hispanic women were more likely to receive open procedures as treatment for ectopic pregnancy compared to white women (OR 1.226, p<0.001). Women with private insurance were more likely to receive open procedures than women who were self-pay for treatment (OR 0.809, p<0.001). Women of lower median income status, <$60,000, were more likely to receive open procedures than women of fourth quartile income group. Black women predominantly made up the first quartile income group. When controlling for covariates, Black women were not more likely to receive one method of surgical procedure over another.

CONCLUSION

Income appears to be related to surgical management of ectopic pregnancy with women of lower median incomes receiving laparotomies over laparoscopic procedures. Equal access to healthcare remains a prudent need in communities of color. Further studies are needed to elucidate surgical decision-making in management of ectopic pregnancy.

Ectopic pregnancy: a resident's guide to imaging findings and diagnostic pitfalls

Ectopic pregnancy (EP) is a term used to describe any pregnancy which does not implant into the uterine cavity. There are several types of EPs: tubal, interstitial, ovarian, abdominal, heterotopic, cervical, and cesarean scar. Ectopic pregnancies can acutely rupture and are the number one cause of maternal death in the first trimester of pregnancy. Therefore, prompt recognition and accurate localization have significant clinical implications on patient outcome. Unfortunately, EPs have many mimickers, which can make the diagnosis challenging in certain cases. In this review, we aim to describe and illustrate sonographic findings of each type of EP, as well as present mimickers and various imaging pitfalls. We will clarify how to avoid potential misdiagnoses that could adversely affect patient outcomes. Lastly, we will briefly address management of each type of EP and discuss potential complications.