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PubMed2006

Transcatheter cryothermal ablation of junctional ectopic tachycardia in the normal heart.

BACKGROUND: Junctional ectopic tachycardia in the normal heart is rare and often is resistant to pharmacologic management. Transcatheter ablation using radiofrequency energy places the AV node at risk. OBJECTIVES: The purpose of this study was to report our experience with transcatheter cryothermal ablation using three-dimensional mapping in six patients with junctional ectopic tachycardia. METHODS: A review of clinical and electrophysiologic data was performed on all patients with structurally normal hearts who underwent cryothermal ablation for treatment of junctional ectopic tachycardia at two institutions. RESULTS: Six patients (age 7.7-36.5 years) underwent attempted transcatheter cryothermal ablation using three-dimensional mapping. Only one patient had achieved arrhythmia suppression on medical management. Cryothermal mapping (-30 degrees C) localized the junctional focus while normal conduction was monitored. The junctional focus was high in the triangle of Koch in four patients and was low in one patient. The sixth patient had only one run of junctional ectopic tachycardia during the procedure and therefore received an empiric cryoablation (-70 degrees C) lesion. Subsequent cryoablation lesions were delivered at and around the junctional focus. In one patient, cryomapping eliminated the junctional focus but resulted in transient complete AV block; therefore, cryoablation was not performed. All patients who received the cryoablation lesions had elimination of their junctional ectopic tachycardia at 6-week follow-up. The patient who did not receive a cryoablation lesion remained in a slower junctional rhythm at follow-up. CONCLUSION: Cryoablation of junctional ectopic tachycardia is safe and effective. Nonetheless, proximity to the His-Purkinje system may preclude success. Empiric cryoablation can be effective; cryotherapy may not yield immediate success, but a delayed salutary effect can follow.

Adolescent↗
PubMed1984

A contemporary approach to suspected ectopic pregnancy with use of quantitative and qualitative assays for the beta-subunit of human chorionic gonadotropin and sonography.

Although assays for the beta-subunit of human chorionic gonadotropin (beta-hCG) and ultrasonography have become popular diagnostic aids in the approach to patients with a suspected ectopic pregnancy, their true utility has not been clearly defined; in fact, the beta-hCG assay is so sensitive that proper clinical interpretation is sometimes difficult. A recent study describing a "discriminatory zone" (beta-hCG level of 6000 to 6500 mIU/ml), which correlates beta-hCG levels with appearance of a gestational sac on ultrasound scans, has been reported to be of diagnostic benefit. A prospective study of 103 women with suspected ectopic pregnancy was undertaken utilizing an algorithm which included beta-hCG assays (quantitative as well as qualitative) and ultrasonography. Seventy-three patients were found not to be pregnant, and seven had a normal pregnancy, 14 patients ultimately had a spontaneous abortion, and seven ectopic pregnancies were identified. The following conclusions were drawn: (1) a qualitative beta-hCG assay with a sensitivity of 25 mIU/ml is an effective test in screening for ectopic pregnancies; (2) the concept of a "discriminatory zone" is valid but not of frequent clinical utility, since most patients suspected of having an ectopic gestation have beta-hCG levels below this zone; (3) serial monitoring of beta-hCG values is an important diagnostic aid; (4) culdocentesis is still an important contemporary diagnostic test for the patient suspected of ectopic pregnancy.

Abortion, Spontaneous↗
PubMed1997

Vaginal douching and the risk of ectopic pregnancy among black women.

OBJECTIVE: Our goal was to determine whether vaginal douching was associated with ectopic pregnancy among black women and whether specific douching behaviors were associated with differences in risk. STUDY DESIGN: We analyzed data from a case-control study of ectopic pregnancy conducted between October 1988 and August 1990 at a major public hospital in Atlanta, Georgia. Case subjects were 197 black women with surgically confirmed ectopic pregnancies; the control group included 882 black women who were delivered of live or stillborn infants and 237 black women who were seeking to terminate a pregnancy. RESULTS: The adjusted odds ratio for ectopic pregnancy associated with ever having douched was 3.8 (95% confidence interval 1.6 to 8.9). The risk increased with increasing number of years of douching at least once per month. No douching behavior was found to be without risk; even women who douched for routine cleanliness were at increased risk of ectopic pregnancy. CONCLUSIONS: Vaginal douching is a modifiable behavior that may greatly increase a woman's risk of ectopic pregnancy.

Adolescent↗
PubMed1998

Fetal fibronectin as a marker to discriminate between ectopic and intrauterine pregnancies.

OBJECTIVE: Our purpose was to determine the accuracy of fetal fibronectin values for diagnosing ectopic pregnancies. STUDY DESIGN: We obtained vaginal swabs from women with pregnancies of < or = 12 weeks' gestation to perform enzyme-linked immunosorbent assays for fetal fibronectin. Fetal fibronectin values were compared among groups categorized on the basis of clinical and laboratory criteria into (1) ectopic pregnancies, (2) threatened abortions, (3) incomplete/complete abortions, and (4) uncomplicated intrauterine pregnancies. RESULTS: Mean fetal fibronectin values ranged from 0.08 microg/mL in women with ectopic pregnancies to 0.33 microg/mL in women with threatened abortions. Comparing these two diagnostic categories, a negative fetal fibronectin test (at a cutoff level of 0.300 microg/mL) predicted ectopic pregnancy with a sensitivity of 94%, specificity of 28%, positive predictive value of 62%, and negative predictive value of 78%. CONCLUSION: Although fetal fibronectin is low in women with ectopic pregnancies, a negative test is not sufficiently sensitive and specific to be used clinically for the diagnosis of ectopic pregnancy.

Abortion, Incomplete↗
PubMed1999

Rhythmic variation in the rate of ectopic pregnancy throughout the year.

OBJECTIVE: This study was conducted to determine whether the incidence of ectopic pregnancy follows a seasonal rhythm of occurrence. STUDY DESIGN: A retrospective analysis was performed on 15,639 pregnancies reported in a single department in 5.5 years (January 1992-June 1997). For each pregnancy the time of conception was estimated from medical records. Frequencies of conceptions that terminated in birth, spontaneous abortion, legally induced abortion, and ectopic pregnancy were distributed across the 12-month period. RESULTS: Total pregnancy showed a seasonal rhythm of occurrence, with peak values in March. The rate of ectopic pregnancy showed a rhythm with 2 peaks, in June and December. Nadirs were coincident with the peak and nadir of total conceptions and also with the equinoxes. Spontaneous abortions tended to show a rhythm the inverse of that of ectopic pregnancy. CONCLUSIONS: These data show an influence of the seasons on the rate of ectopic pregnancy, which may have implications for both the understanding of ectopic pregnancy's causative mechanisms and its prevention.

Abortion, Spontaneous↗
PubMed1979

Copper T IUD use and ectopic pregnancy rates in the United States.

Over a four-year exposure period, the rate of ectopic pregnancy for women using a Copper T IUD was less than 1 per 1000 years of use. The cumulative 4-year probability of having an ectopic pregnancy while using the Copper T was 4 per 1000 women. These results are based on a study of 35,496 women with 38,064 years of use. Data on ectopic pregnancies in the United States provide a basis with which IUD experience may be compared. The National Hospital Discharge Survey shows a doubling in the number of ectopic pregnancies and in the incidence rates between 1965 and 1976. The relative risk of ectopic pregnancy among IUD users as compared with sexually active women not using the pill or sterilization may have been above 1 in 1965. In 1976, the relative risk is estimated to have been below 1. Compared with all woman-years of exposure, including women using contraceptive sterilization and the pill, the relative risk of extopic pregnancy to IUD users in 1976 was about 1. The IUD could not have been a major factor contributing to the recent doubling in the rate of ectopic pregnancy in the U.S.

Adult↗
PubMed2001

Survival analysis of fertility after ectopic pregnancy.

OBJECTIVE: To evaluate the reproductive outcome after ectopic pregnancy and to assess the contribution of risk factors to future fertility. DESIGN: Prospective follow-up in a population-based sample. SETTING: Register of ectopic pregnancies established in an urban area around Lille, France. PATIENT(S): Three hundred and twenty-eight women treated between April 1994 and March 1997 who had not been using an IUCD at the time of the ectopic pregnancy and were trying to become pregnant. INTERVENTION(S): Interviews by telephone every 6 months for 2 years and once yearly thereafter. MAIN OUTCOME MEASURE(S): Cumulative pregnancy rate. RESULT(S): Two hundred fifteen (65.5%) women became pregnant after a mean of 5 months. One hundred eighty-two (84.7%) pregnancies were intrauterine; 22 (10.2%) were recurrent ectopic pregnancies; and in 11 women (5.1%), it was too early to define implantation. The cumulative intrauterine pregnancy rate was 56% at 1 year and 67% at 2 years. After applying Cox regression, three factors associated with fertility seemed to decrease reproductive performance: age > 35 years, history of infertility, and anterior tubal damage . CONCLUSION(S): More than half of the women treated for ectopic pregnancy spontaneously conceived and had a normally progressive pregnancy at 1 year. Fertility depends more on established patient characteristics than characteristics of ectopic pregnancy itself or treatment thereof.

Adult↗
PubMed1982

Salpingostomy for ectopic pregnancy in the sole patent oviduct: reproductive outcome.

The ultimate success of conservative surgery for tubal ectopic pregnancy is difficult to evaluate in the presence of a potentially normal contralateral fallopian tube. Fifteen cases of tubal pregnancy with only one functional fallopian tube were treated by linear salpingostomy at Yale-New Haven Hospital between 1975 and 1980. The overall term viable pregnancy rate to date is 53%; the recurrent ectopic pregnancy rate is 20%. Twenty-seven percent of those patients operated upon until now have not conceived. These statistics are based on a 100% follow-up of at least 1 year, with all patients trying actively to conceive. Review of the literature on conservative treatment of ectopic pregnancy when only one tube is present reveals an intrauterine pregnancy rate of 61% and a repeat ectopic pregnancy rate of 17%. We conclude that linear salpingostomy is an acceptable surgical technique for the treatment of tubal ectopic pregnancy, because this experiment, by its nature, eliminates the variable performance of the contralateral tube in relationship to subsequent intrauterine pregnancy and repeat ectopic pregnancy in these patients.

Fallopian Tubes↗
PubMed1985

Reproductive outcome following two ectopic pregnancies.

Consideration of reproductive potential following multiple ectopic pregnancies is important in counseling patients and when choosing a conservative surgical approach (salpingotomy, salpingostomy), partial salpingectomy, or in vitro fertilization. The cases of 336 patients at Yale-New Haven Hospital who had ectopic pregnancies between 1976 and 1981 were evaluated. Thirty-two patients (9.5%) had two ectopic pregnancies. Twenty-three patients (71.8%) were followed. Six of these (26.1%) were not able to conceive because of surgical sterilization, and four (17.4%) were not trying to conceive. Of those 13 patients (56.5%) actively trying to conceive and having at least one tube remaining, 4 (30.8%) had term intrauterine gestations. One had a third ectopic gestation, which represented 20% of all conceptions, or 7.7% of those individuals trying to conceive. Our results indicate that although the reproductive potential after two ectopic pregnancies is poor, viable pregnancies do occur, and the repeat ectopic pregnancy rate is not high enough to preclude a repeat conservative surgical approach.

Abortion, Therapeutic↗
PubMed1993

The association between Chlamydia trachomatis serology and pelvic damage in women with tubal ectopic gestations.

OBJECTIVE: To determine whether pelvic damage is associated with positive Chlamydia trachomatis serology in women with tubal ectopic pregnancy. DESIGN: Cross-sectional retrospective study. SETTING: A prepaid health maintenance organization. PATIENTS: Two-hundred eighty-one women admitted with confirmed tubal ectopic pregnancy were interviewed for history of sexually transmitted diseases. Chlamydia serology was obtained for 135 subjects, and operative findings were available for 121 of these. INTERVENTIONS: None. MAIN OUTCOME MEASURE: Pelvic damage, as determined by review of operative findings of the pelvis at the time of ectopic surgery. RESULTS: Pelvic damage was associated with positive chlamydia serology with an adjusted odds ratio of 4.2 (95% confidence interval: 1.8 to 9.7). Moderate and severe pelvic damage were more strongly associated with positive serology than mild damage. CONCLUSIONS: Women with ectopic pregnancies and antibodies to C. trachomatis are more likely to have damaged pelves than women with ectopic pregnancies without such antibodies. Prevention or early treatment of C. trachomatis infection may reduce pelvic damage and, therefore, reduce incidence of ectopic pregnancy.

Adult↗
PubMed1988

Persistent tubal ectopic gestation: patterns of circulating beta-human chorionic gonadotropin and progesterone, and management options.

To aid in the clinical decision making involved with persistent ectopic gestation, a total of 329 operative procedures for tubal gestation were reviewed. Six of 114 (5.3%) cases treated conservatively had persistent trophoblastic activity. The decline in serum beta-human chorionic gonadotropin (hCG) and progesterone (P) at 3 and 6 days postoperatively was similar in the "persistent ectopic" and the "resolved ectopic" groups. However, beyond day 6 both beta-hCG percentage of baseline and P level were significantly higher in the "persistent ectopic" (greater than 22.6 +/- 6.6%, greater than 3.4 +/- 0.7 ng/ml, respectively) than the "resolved ectopic" group (less than 2.7 +/- 0.8%, less than 0.2 +/- 0.05 ng/ml, respectively). Four patients underwent a second operation, whereas two were managed expectantly. These data suggest that the diagnosis of persistent ectopic gestation is best made by an initial measurement of serum beta-hCG or P at 6 days postoperatively, and at 3 day intervals thereafter. The choice of management may be determined by various factors including serum beta-hCG and patient's symptoms.

Adult↗
PubMed2001

Diagnosing ectopic pregnancy: decision analysis comparing six strategies.

OBJECTIVE: To compare six published methods of diagnosing ectopic pregnancy. METHODS: Decision analysis compared six diagnostic algorithms involving combinations of clinical examination, transvaginal ultrasound, serum progesterone, serum hCG, and D&C. The population was composed of hemodynamically stable women who presented to a tertiary care university emergency department with abdominal pain or bleeding in their first trimesters. Outcome measures included number of missed ectopic pregnancies, potentially interrupted intrauterine pregnancies, surgical and diagnostic procedures, time until diagnosis, and cost. RESULTS: Ultrasound followed by serum hCG in women with nondiagnostic scans yielded the most favorable outcomes; no ectopic pregnancy was missed, only 1% of all potential intrauterine pregnancies were interrupted, and time to diagnosis averaged 1.46 days. Quantitative hCG measurement followed by ultrasound only in women with hCG levels above the discriminatory zone was optimal if sensitivity of ultrasound to diagnose intrauterine pregnancy was less than 93%. Serum progesterone measurement was not favored because it was associated with missed ectopic pregnancies (2.6%). CONCLUSION: Given the current accuracy of tests for diagnosing ectopic pregnancy, algorithms using a combination of ultrasound and hCG resulted in the best outcomes. Ultrasound as the first step was the most efficient and accurate method of diagnosing ectopic pregnancies.

Chorionic Gonadotropin↗
PubMed1998

Resolution of hormonal markers of ectopic gestation: a randomized trial comparing single-dose intramuscular methotrexate with salpingostomy.

OBJECTIVE: To evaluate resolution of serum hCG and progesterone in patients with ectopic pregnancy receiving single-dose intramuscular (IM) methotrexate as compared with those undergoing laparoscopic salpingostomy. METHODS: In this prospective randomized clinical trial, 75 hemodynamically stable women with a diagnosis of ectopic pregnancy were randomized to treatment with single-dose IM methotrexate (1 mg/kg) or laparoscopic salpingostomy. All women had initial, day 4, and weekly serum hCG and progesterone measurements taken until hCG levels were less than 15 mIU/mL. Methotrexate therapy was repeated if posttreatment day 7 hCG levels did not decrease by 15%, as compared with day 4 levels. Success rate was defined as ectopic resolution without the need for the alternate mode of therapy. RESULTS: Thirty-eight women were randomized to treatment with methotrexate and 37 to laparoscopic salpingostomy. The mean (+/-standard deviation) time required for serum progesterone concentrations to decrease to less than 1.5 ng/mL was significantly less for laparoscopic salpingostomy than for treatment with methotrexate: 7.8+/-1.7 and 17.6+/-2.2 days, respectively (P < .01). Within each treatment group, serum progesterone levels resolved (less than 1.5 ng/mL) more rapidly than did hCG levels (less than 15 mIU/mL) (P < .01). No further treatment was required once serum progesterone levels had decreased to less than 1.5 ng/mL. Success rates were similar in both groups: 94.7% (36 of 38) for methotrexate and 91.4% (33 of 36) for laparoscopic salpingostomy. Mean time required for hCG concentrations to decrease to less than 15 mIU/mL was significantly less for laparoscopic salpingostomy than for methotrexate therapy: 20.2+/-2.7 and 27.2+/-2.3 days, respectively (P < .05). Additional methotrexate injections were required in 15.8% (6 of 38) of women randomized to methotrexate therapy. Initial serum hCG levels for patients receiving additional methotrexate doses were 4830+/-1588 mIU/mL as compared with 2133+/-393 mIU/mL for women receiving only one dose (P = .07). CONCLUSION: Serum progesterone levels of less than 1.5 ng/mL are a good predictor of ectopic pregnancy resolution regardless of treatment, and because its return to normal values occurs more rapidly than that of hCG levels, serum progesterone may be a better marker for predicting successful treatment. Although laparoscopic salpingostomy leads to faster resolution of hormonal markers of ectopic gestation, methotrexate is equally successful for treating small unruptured ectopic pregnancies. Initial hCG levels may be a marker for women requiring additional doses of methotrexate.

Abortifacient Agents, Nonsteroidal↗
PubMed1999

Rate of change of serial beta-human chorionic gonadotropin values as a predictor of ectopic pregnancy in patients with indeterminate transvaginal ultrasound findings.

STUDY OBJECTIVE: To determine the predictive value of the rate of change of serial beta-human chorionic gonadotropin (hCG) values in patients with symptoms suggestive of ectopic pregnancy but who have indeterminate transvaginal ultrasound findings, and to determine whether the predictive value was enhanced depending on whether the endometrial cavity was empty at ultrasound examination. METHODS: A retrospective study was performed on consecutive emergency department patients from August 1, 1991, through August 1, 1998, presenting with abdominal pain or vaginal bleeding, a positive beta-hCG test result, and indeterminate transvaginal ultrasound findings. Patients were eligible for the study if they had a second beta-hCG assay performed within 7 days of the initial visit and before either a diagnostic dilation and evacuation or laparoscopy. Patients were excluded if they were lost to follow-up. Patients were divided into 4 groups based on the rate of change of beta-hCG values over a 48-hour interval (increase by >66%, increase by <66%, decrease by <50%, decrease by >50%). In addition, the 4 main groups were further subdivided depending on whether the endometrial cavity was empty at ultrasound examination. Intergroup differences in the frequency of ectopic pregnancy based on the rate of change of the beta-hCG value were compared using logistic regression. Logistic regression also was used to determine whether addition of the ultrasound result improved predicative accuracy. A P value of less than.05 was considered significant. Odds ratios (ORs) were determined for each subgroup. RESULTS: Three hundred thirty-one eligible patients were identified; of these, 24 were excluded. Of the 307 enrolled patients, 33 (10.7%) had a final diagnosis of ectopic pregnancy. Intergroup differences in the frequency of ectopic pregnancy based on the beta-hCG rate of change were significant (P<.0001). Addition of the ultrasound result to this model further improved predicative accuracy (P<.0001). Overall, patients with increasing beta-hCG values were at increased risk compared with those with decreasing beta-hCG values, and patients with empty uteri at ultrasound were at increased risk compared with those with uteri that were not empty. Combining the beta-hCG rate of change with the ultrasound result identified 3 high-risk groups: patients with beta-hCG values that increased by less than 66% and an empty uterus at ultrasound (OR 24.8); patients with beta-hCG values that decreased by less than 50% and an empty uterus at ultrasound (OR 3.7); and patients with beta-hCG values that increased by more than 66% and an empty uterus at ultrasound (OR 2.6). Patients with beta-hCG values that decreased by more than 50% were found to be at low risk for ectopic pregnancy irrespective of the specific endometrial findings at ultrasound. CONCLUSION: The rate of change of serial beta-hCG values, in patients with an indeterminate pelvic ultrasound examination, is predictive of ectopic pregnancy. Addition of whether the endometrial cavity is empty at ultrasound leads to a further improvement in predictive accuracy.

Chorionic Gonadotropin, beta Subunit, Human↗
PubMed1997

Clinical and financial analyses of ectopic pregnancy management at a large health plan.

STUDY OBJECTIVE: To compare three treatment options for ectopic pregnancy-laparotomy, laparoscopy, and methotrexate-including clinical aspects, costs, and reproductive outcomes. DESIGN: Retrospective review of outpatient and inpatient records of all patients with a diagnosis of ectopic pregnancy insured by Fallon Community Health from 1990 to 1995. SETTING: Multispecialty group practice and a university-affiliated private hospital. PATIENTS: One hundred seven women treated for ectopic pregnancy. INTERVENTIONS: Thirty-six women were treated by laparotomy, 58 by laparoscopy, and 13 by single-dose intramuscular methotrexate. Data from the chart review were analyzed to define differences among the three groups with respect to several predetermined outcome variables: initial symptoms, risk factors, human chorionic gonadotropin levels, size of ectopic gestation, procedure types, rupture rates, surgical outcomes and morbidity, failure rates, length of convalescence, reproductive outcomes, and costs. MEASUREMENTS AND MAIN RESULTS: The incidence of ectopic pregnancy was 8.6/1000 reported pregnancies. Initially, 38% of surgical patients had laparoscopic treatment, but by 1995 the figure reached 100%. From 1994 to 1995, 13 (29%) of 45 pregnancies were treated with single-dose methotrexate. Compared with laparoscopy, length of stay was significantly longer for laparotomy (3.1 vs 1.3 days), as was recuperation time (2.4 vs 4.6 wks). Laparotomy had similar rates of total complications as laparoscopy (13.9% vs 10.3%). The rate of treatment failures (persistent trophoblastic activity) were 2.7% and 3.4%, respectively. The rate of persistence for laparoscopic salpingostomy was 6.1%. Methotrexate therapy resulted in no tubal ruptures or treatment failures. Two of 13 women required a second injection. The only complication of methotrexate therapy was mild leukocytopenia in one patient. Total charges were similar for laparotomy and laparoscopy ($6720 vs $6840). Outpatient methotrexate therapy cost significantly less than the two surgical procedures (average $818/case, p < 0.001). Laparotomy resulted in similar intrauterine pregnancy rates as laparoscopy (66% vs 77%), and similar repeat tubal pregnancy rates (17% vs 7%). CONCLUSION: The results of this study support laparoscopy and methotrexate as efficacious, safe, and cost effective for the treatment of ectopic pregnancy compared with laparotomy. Reproductive outcomes were similar among the three groups.

Adolescent↗
PubMed1997

The influence of demographic change and cumulative risk of pelvic inflammatory disease on the incidence of ectopic pregnancy.

A retrospective study was carried out to determine the recent epidemiology of ectopic pregnancy in England between the biennial years 1988/9 and 1992/3. The number of ectopic pregnancy cases were combined with numbers of conceptions and the rates analysed for trend over time. The incidence of ectopic pregnancy rose significantly (P = 0.05) over this period. However, this could be entirely explained by increasing numbers of births in older women and a highly significant positive association was found between risk of ectopic pregnancy and maternal age (P < 0.0001). Over the study period the incidence of ectopic pregnancy in women aged 40 years or more was over 14 times that observed in those under 16 years of age. It is suggested that this reflects cumulative risk of acquiring pelvic inflammatory disease. The surveillance of ectopic pregnancy provides a useful indicator of the level of reproductive morbidity in women.

Adolescent↗
PubMed2001

Clinical and pregnancy outcome following ectopic pregnancy; a prospective study comparing expectancy, surgery and systemic methotrexate treatment.

BACKGROUND: The improved possibility of an early diagnosis of ectopic pregnancy by use of serial quantitative beta-subunit human chorionic gonadotropin hormone levels together with transvaginal ultrasound has opened up options for conservative treatment. Systemic methotrexate treatment of unruptured ectopic pregnancy has emerged as a safe and effective alternative to surgical procedures. The aim of the present study was to investigate the effectiveness of methotrexate treatment in routine clinical practice, but also to assess pregnancy outcome during a 2.5-year follow-up period. METHODS: All patients presenting to the Department of Obstetrics and Gynecology, Umeå University Hospital, with signs and symptoms of ectopic pregnancy between January 1, 1995 and December 31, 1997 were included in this prospective study. Patients with ectopic pregnancy were either managed expectantly, treated with methotrexate or by laparoscopic or open surgery (salpingostomy/salpingectomy). Systemic methotrexate (Pharmacia & Upjohn, Stockholm, Sweden) was administered as an intramuscular injection of 50 mg/m(2). RESULTS: One hundred and seven patients presented with signs and symptoms of a possible ectopic pregnancy, of these 89 patients eventually were diagnosed as having an ectopic pregnancy. Twenty-six (29%) patients were treated with methotrexate, 46 (52%) patients with laparoscopy or laparotomy, and 17 (19%) patients by expectant management. Success rate in the methotrexate group, after one or more injections, was 77% (20 patients out of 26). The mean time to resolution was 24+/-9 days. There was no difference in pregnancy rate following methotrexate treatment compared to surgical treatment. CONCLUSIONS: Systemic single-dose methotrexate treatment is a safe treatment option with a reasonably high success rate, with similar probability of a later intrauterine pregnancy as conventional surgical treatment.

Abortifacient Agents, Nonsteroidal↗
PubMed2002

Ectopic pregnancy revisited in Benin City, Nigeria: analysis of 152 cases.

BACKGROUND: Ectopic pregnancy is still a major health problem among women of childbearing age in our community. The majority of the patients with ectopic pregnancy are nulliparous in their mid twenties, with previous induced abortion(s) and or pelvic inflammatory disease. It remains a major challenge to the reproductive performance of women worldwide. OBJECTIVE: The study is an analysis of the clinical profile of patients presenting with ectopic pregnancy, to investigate the current status of the incidence, predisposing risk factors and the management options available in Benin. MATERIALS AND METHODS: One hundred and fifty two cases of ectopic pregnancies managed at the University of Benin Teaching Hospital (UBTH) between January 1994 and December 1998 were analyzed. Clinical and socio-biological information were retrieved from patients' case notes, and supplemented by information from the operating theatre and ward registers. RESULTS: The incidence of ectopic pregnancy during this study period was 1. 68% of total births and 6.74% of and gynecologic admissions. Nulliparous patients were 49.3%, while the peak age of incidence was 20-25 years. 95/152 (62.5%) of the patients had previous induced abortion(s), while pelvic adhesions were noted in 62/152 (40.85 approximately %). 67.8% of the patients were not using any method of contraception, while 13.8% and 9.2% were using lUD and barrier methods, respectively. Abdominal pain, 2 degrees amenorrhoea and irregular vaginal bleeding (83.6%, 77.5% and 73.7%, respectively) were the most frequent presenting complaints. 75/152 of the patients (49.3%) were in a state of shock, and 80.3% had ruptured tubal pregnancy at presentation. All patients had laparotomy, 54.6% and 34.9% had right and left salpingectomy, respectively. 831/52 of the patients (54.6%) had autotransfusion during surgery. CONCLUSION: In Benin, the majority of the patients with ectopic pregnancy are nulliparous in their mid twenties, with history of previous induced abortion(s) and or pelvic inflammatory disease. Management option is limited to laparotomy and salpingectomy.

Abortion, Induced↗