Medical management of ectopic pregnancy if you have been diagnosed with an ectopic pregnancy we understand this may be a very distressing time and we are sorry for your loss. Medical management of ectopic pregnancy sciencedirect. Laparoscopic management of ectopic pregnancy at birat. Medical management of ectopic pregnancy protocol cg623 approval and authorisation. This guideline will cover the following ectopic pregnancies. Medical management of an ectopic pregnancy is with im methotrexate. Diagnosis and management of ectopic pregnancy bmj sexual. The rate of increase in hcg is one predictor of rupture. This guideline replaces the management of tubal pregnancy, which. Methotrexate can be considered in those women with a confirmed, or high clinical suspicion of, ectopic pregnancy who are hemodynamically stable with an unruptured mass.
Currently, women may also be offered medical management, with the use of methotrexate an antifolate agent if they are haemodynamically stable with confirmed diagnosis of ectopic pregnancy on ultrasound scan, no significant pelvic pain, no hemoperitoneum, no fetal heart in the ectopic pregnancy, size of ectopic pregnancy 10 iul 34. Medical management of ectopic pregnancy with methotrexate, an antimetabolite of folic acid, is an important alternative to surgical treatment, as it. The development of algorithms for diagnosis and medical management using mtx has. Medical management of ectopic pregnancy clinical practice. Diagnosis and management of ectopic pregnancya basic view. After an ectopic pregnancy has been confirmed, treatment options include medical, surgical, or expectant management. In current practice, in developed countries, diagnosis. This is a policy for maternity services with respect to the management of early pregnancy complications in early pregnancy assessment service s epas. However, of those who underwent or elected surgical management, only 3% had a ruptured ectopic pregnancy in the course of the study. An hcg level that remains high could indicate that the ectopic tissue was not entirely removed, which would require surgery or medical management with methotrexate. This document has been withdrawn or is no longer available.
Although ectopic pregnancy remains a leading cause of lifethreatening firsttrimester morbidity, accounting for about 9% of maternal deaths annually, 1 we now are able to diagnose and treat most cases well before rupture occursin some cases, as early as 5 weeks gestation. Most cases of tubal ectopic pregnancy that are detected early can be treated successfully either with minimally invasive surgery or with medical management using methotrexate. Medical management as with all types of ectopic pregnancy, medical management of abdominal pregnancy has been reported. The objective of management in ectopic pregnancy is to make an early diagnosis, treat, prevent complications, and consequently to improve. Diagnosis and management of ectopic pregnancy 2016 bjog. See table 1 for a summary of medical management protocols. Other indications for surgery include no desire for or an inability to comply with medical treatment, contraindication to methotrexate, and failure of medical treat. Failure of the hcg level to decrease by at least 15% from day 4 to day 7 after methotrexate administration is considered treatment failure requiring therapy with either. Since ectopic pregnancy is extensive increasing trouble in the women of reproductive age. Salpingectomy is the common surgical method for the. Ectopic pregnancy is defined as a pregnancy that occurs outside of the uterine cavity. A healthy 29yearold woman who has been trying to conceive presents with vaginal spotting for the past 5 days and intermittent crampy abdominal pain in her left lower quadrant for the past 3 days. The aetiology of ectopic pregnancy remains uncertain although a number of risk factors have been identified. It is an antifolate cytotoxic agent that disrupts the folate dependent cell division of the developing fetus.
If ectopic pregnancy has been diagnosed, the patient is deemed clinically stable, and the affected fallopian tube has not ruptured, treatment options include medical management with intramuscular. There was also a secondary finding of a corpus luteum cyst. The most common site of ectopic pregnancy is the fallopian tube. Therefore immediate effective treatment and management are required to save women.
A decrease in beta hcg by more than 15% between day 4 and day 7 after treatment shows successful medical treatment. Ectopic pregnancy is a lifethreatening obstetric emergency and a leading cause of maternal mortality and morbidity around the globe. Suspect ectopic pregnancy in a client whose history includes a missed menstrual period, spotting, or bleeding pelvic or shoulder pain, use of intrauterine device, pelvic infections, tubal surgery, or previous ectopic pregnancy. Its given as a single injection into your buttocks.
The incidence of ectopic pregnancy showed a steady increase with the increase in maternal age at conception from 1. Theyre also called tubal pregnancies because most of them happen in the fallopian tubes. Diagnosis and management of ectopic pregnancy aafp. There are different criteria for its use, and published success rates are heterogeneous. If the diagnosis of ectopic pregnancy can be made earlier noninvasively, medical treatment with systemic intramuscular methotrexate mtx aimed at reducing. Clinical practice guideline the diagnosis and management of ectopic pregnancy 3 key recommendations 1. However, tubal ectopic pregnancy in an unstable patient is a medical emergency that requires prompt surgical intervention. Draft clinical practice guideline the diagnosis and management of ectopic pregnancy 3 key recommendations. As a result, medical therapy with systemic methotrexate has become the firstline treatment, with surgery reserved. Agents used to treat these ectopic pregnancies include methotrexate systemic and local,4,31 local instillation of potassium chloride,32 hyperosmolar glucose, prostaglandins, danazol, etoposide and mifepristone.
For patients who are medically unstable or experiencing lifethreatening. The estimated prevalence of ectopic pregnancy is 12% worldwide. Diagnosis and management of ectopic pregnancy greentop. When administering methotrexate therapy, it is essential to remain aware of the risks and side effects of medical management. Maternity management of early pregnancy complications. In clinically stable women in whom a nonruptured ectopic pregnancy has been diagnosed, laparoscopic surgery or. An ectopic pregnancy occurs when a fertilized egg implants itself outside of the uterus. The majority of ectopic pregnancies occur in the fallopian tube 96 percent, but other possible sites include cervical, interstitial also referred to as cornual, a pregnancy located in the proximal segment of the fallopian tube that is embedded within the muscular wall of the uterus, hysterotomy scar eg, in.
The diagnosis and management of pregnancy of unknown location will not be covered. You wont need to stay in hospital after treatment, but regular blood tests will be carried out. Medical management has become increasingly popular in the treatment of ectopic pregnancy. Primary ovarian ectopic pregnancy is a rare type of ectopic pregnancy which has an estimated prevalence ranging from 1. Medical management of ectopic pregnancy request pdf.
The chances of having a successful pregnancy after an ectopic pregnancy may be reduced, but this will depend on why the pregnancy was ectopic and your medical history. Hcg levels and successful medical management of an ectopic pregnancy. The use of methotrexate to treat ectopic pregnancy was first cited in 1982. It is usually terminated by a rupture in the first trimester and because of the increased vascularization of the ovarian tissue it leads to internal hemorrhage and hypovolemic shock status. Hcg level is monitored regularly to ensure the level is declining by 15% in day 45. In the united kingdom nearly 12 000 ectopic pregnancies are diagnosed each year, which gives a prevalence of 1. The etiology of ep concentrated mainly on factor causes delayed transport of the fertilized ovum through the fallopian tube favors implantation in tubal mucosa, thus giving rise to ep.
New 2016 c women receiving methotrexate for the management of tubal ectopic pregnancy can be advised that there is. An ectopic pregnancy is a pregnancy outside of the uterine cavity. June 2008 volume 111 issue 6 p 14791485 acog publications. Rupture of ectopic pregnancy during methotrexate treatment ranges from 714%. Surgical management of ectopic pregnancy natural progress of t ubal ectopic pregnancy. Pdf medical management of ectopic pregnancy a case history. To date there have been no wellpowered comparative studies between the two dose protocol and the single dose protocol, or the multidose protocol. An ectopic pregnancy occurs when a fertilised ovum implants outside the normal uterine cavity. Women of reproductive age presenting acutely with gastrointestinal symptoms, particularly diarrhoea, as well as those presenting with abdominal pain andor vaginal bleeding should have a urinary hcg test.
Foster, dphil, md, am amanda dennis, mbe fiona smith, mph acknowledgements this research was conducted by ibis reproductive health for the national womens law center. Diagnosis and management of ectopic pregnancy the bmj. Your doctor has suggested that it is appropriate to treat your ectopic pregnancy with a drug called methotrexate. Medical management of an ovarian ectopic pregnancy. If an ectopic pregnancy is diagnosed early but active monitoring isnt suitable, treatment with a medicine called methotrexate may be recommended. An ectopic pregnancy ep falls within the area of the gynecological emergency andor reproductive management of women, which is the implantation of fertilized ovum outside the endometrial cavity.
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