Four-year experience in medical treatment of ectopic pregnancy in the department of Paysandú
Keywords:
ECTOPIC PREGNANCY, METHOTREXATE, FERTILITY
Abstract
Introduction: In recent years there has been a decrease in deaths related to ectopic pregnancy, thanks to progress made in early diagnosis, which in turn allowed for medical treatment with methotrexate in selected patients.
The study’s first objective is to report the experience of methotrexate treatment in the Department of Paysandú and its secondary objective is to determine users’ satisfaction towards this treatment and find about their subsequent fertility.
Method: a retrospective, observational study is presented of tubal ectopic pregnancies treated with methotrexate in Paysandú, from January 1, 2014 to December 31, 2017, during a 4-year period. Failure of medical treatment was defined as the cases requiring surgical treatment and subsequent fertility was defined as the time it took to achieve a spontaneous intrauterine gestation. Results: 67 ectopic pregnancies were recorded in four years, 13 of which received intramuscular methotrexate with a success rate of 69.2%. Subsequent fertility was found to be 25%. Conclusions: methotrexate has been used to treat ectopic pregnancies in Paysandú for almost a decade, with good results and acceptable rates of user satisfaction.
References
(1) Embarazo ectópico. En: Cunningham F, Leveno K, Bloom S, Hauth J, Rouse D, Spong C. Williams obstetricia. 23 ed. México: Mc Graw-Hill Interamericana, 2011:238-55.
(2) Centers for Disease Control and Prevention. Ectopic pregnancy mortality - Florida, 2009-2010. MMWR Morb Mortal Wkly Rep 2012; 61(6):106-9. Disponible en: https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6106a2.htm. (Consulta: 17 junio 2020).
(3) Salvador Alarcón C, Callejo Olmos J, Laílla Vicens J. Embarazo ectópico. En: González Merlo J, Laílla Vicens J, Fabre González E, González Bosquet E. Obstetricia. 6 ed. Barcelona: Elsevier, 2013:331-45.
(4) Mol F, Mol B, Ankum W, van der Veen F, Hajenius P. Current evidence on surgery, systemic methotrexate and expectant management in the treatment of tubal ectopic pregnancy: a systematic review and meta-analysis. Hum Reprod Update 2008; 14(4):309-19. doi: 10.1093/humupd/dmn012.
(5) Embarazo ectópico. En: Fescina R, De Mucio B, Ortiz E, Jarquin D. Guías para la atención de las principales emergencias obstétricas. Publicación científica CLAP/SMR 1594. Montevideo: CLAP/SMR, 2012:25-32. Disponible en: http://www.paho.org/clap/index.php?option=com_docmanHYPERLINK "http://www.paho.org/clap/index.php?option=com_docman&view=download&category_slug=salud-de-mujer-reproductiva-materna-y-perinatal&alias=279-guias-para-la-atencion-de-las-principales-emergencias-obstetricas-1&Itemid=219&lang=es"&HYPERLINK "http://www.paho.org/clap/index.php?option=com_docman&view=download&category_slug=salud-de-mujer-reproductiva-materna-y-perinatal&alias=279-guias-para-la-atencion-de-las-principales-emergencias-obstetricas-1&Itemid=219&lang=es"view=downloadHYPERLINK "http://www.paho.org/clap/index.php?option=com_docman&view=download&category_slug=salud-de-mujer-reproductiva-materna-y-perinatal&alias=279-guias-para-la-atencion-de-las-principales-emergencias-obstetricas-1&Itemid=219&lang=es"&HYPERLINK "http://www.paho.org/clap/index.php?option=com_docman&view=download&category_slug=salud-de-mujer-reproductiva-materna-y-perinatal&alias=279-guias-para-la-atencion-de-las-principales-emergencias-obstetricas-1&Itemid=219&lang=es"category_slug=salud-de-mujer-reproductiva-materna-y-HYPERLINK "http://www.paho.org/clap/index.php?option=com_docman&view=download&category_slug=salud-de-mujer-reproductiva-materna-y-perinatal&alias=279-guias-para-la-atencion-de-las-principales-emergencias-obstetricas-1&Itemid=219&lang=es"perinatalHYPERLINK "http://www.paho.org/clap/index.php?option=com_docman&view=download&category_slug=salud-de-mujer-reproductiva-materna-y-perinatal&alias=279-guias-para-la-atencion-de-las-principales-emergencias-obstetricas-1&Itemid=219&lang=es"&HYPERLINK "http://www.paho.org/clap/index.php?option=com_docman&view=download&category_slug=salud-de-mujer-reproductiva-materna-y-perinatal&alias=279-guias-para-la-atencion-de-las-principales-emergencias-obstetricas-1&Itemid=219&lang=es"alias=279-guias-para-la-atencion-de-las-principales-emergencias-obstetricas-1HYPERLINK "http://www.paho.org/clap/index.php?option=com_docman&view=download&category_slug=salud-de-mujer-reproductiva-materna-y-perinatal&alias=279-guias-para-la-atencion-de-las-principales-emergencias-obstetricas-1&Itemid=219&lang=es"&HYPERLINK "http://www.paho.org/clap/index.php?option=com_docman&view=download&category_slug=salud-de-mujer-reproductiva-materna-y-perinatal&alias=279-guias-para-la-atencion-de-las-principales-emergencias-obstetricas-1&Itemid=219&lang=es"Itemid=219HYPERLINK "http://www.paho.org/clap/index.php?option=com_docman&view=download&category_slug=salud-de-mujer-reproductiva-materna-y-perinatal&alias=279-guias-para-la-atencion-de-las-principales-emergencias-obstetricas-1&Itemid=219&lang=es"&HYPERLINK "http://www.paho.org/clap/index.php?option=com_docman&view=download&category_slug=salud-de-mujer-reproductiva-materna-y-perinatal&alias=279-guias-para-la-atencion-de-las-principales-emergencias-obstetricas-1&Itemid=219&lang=es"lang=es. (Consulta: 17 junio 2020).
(6) Mallick R, Odejinmi F, Clark T. Covid 19 pandemic and gynaecological laparoscopic surgery: knowns and unknowns. Facts Views Vis Obgyn 2020; 12(1):1-5. Disponible en: https://mk0britishsociep8d9m.kinstacdn.HYPERLINK "https://mk0britishsociep8d9m.kinstacdn.com/wp-content/uploads/2020/04/Covid-19-pandemic-and-gynaecological-laparoscopic-surgery-knowns-and-unknowns.pdf"com/wp-content/uploads/2020/04/Covid-19-pandemic-and-gynaecological-laparoscopic-surgery-knowns-and-unknowns.pdf (Consulta: 17 junio 2020).
(7) Ramanah R, Marguier I, Mottet N, Magnin C, Riethmuller D. Embarazo extrauterino. EMC Ginecol Obstetr 2018; 54(3):1-14. doi: 10.1016/S1283-081X(18)91440-2.
(8) Sociedad Española de Ginecología y Obstetricia. Embarazo ectópico. Prog Obstet Ginecol 2007; 50(6):377-85. Disponible en: http://www.elsevier.es/es-revista-progresos-obstetricia-ginecologia-151-pdf-13106416-S300. (Consulta: enero 2017).
(9) Casas M, Sánchez J. Consideraciones éticas sobre el uso de metotrexate en el embarazo tubario (ET). Acta Bioeth 2012; 18(2):147-53. Disponible en: https://scielo.conicyt.cl/scielo.php?script=sci_arttextHYPERLINK "https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S1726-569X2012000200002"&HYPERLINK "https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S1726-569X2012000200002"pid=S1726-569X2012000200002. (Consulta: 17 junio 2020).
(10) Ruiz-Velasco V. Manejo actual del embarazo ectópico en la paciente estéril y en la que se desea conservar su fertilidad futura: actualización, Prog Obstet Ginecol 2010; 53(9):351-63. doi:10.1016/j.pog.2010.04.001.
(11) Song T, Kim M, Kim M, Jung Y, Yun B, Seong S. Single-dose versus two-dose administration of methotrexate for the treatment of ectopic pregnancy: a randomized controlled trial. Hum Reprod 2016; 31(2):332-8. doi: 10.1093/humrep/dev312.
(12) Practice Committee of American Society for Reproductive Medicine. Medical treatment of ectopic pregnancy: a committee opinion. Fertil Steril 2013; 100(3):638-44. doi: 10.1016/j.fertnstert.2013.06.013.
(13) Sánchez-Hidalgo L, López de la Manzanara C, Alpuente A, Garrido R, Sánchez- Hipólito L, González-López A. Evaluación del tratamiento médico del embarazo ectópico con metotrexato, Clin Invest Gin Obst 2012; 39(6):249-52. Disponible en: https://vdocuments.sitHYPERLINK "https://vdocuments.site/evaluacion-del-tratamiento-medico-del-embarazo-ectopico-con-metotrexato.html"e/evaluacion-del-tratamiento-medico-del-embarazo-ectopico-con-metotrexato.html. (Consulta: 17 junio 2020).
(14) Centre de Medicina Fetal i Neonatal de Barcelona. Protocolo: gestación ectópica tubárica y no tubárica. Barcelona: Hospital Clínic, Universitat de Barcelona, 2018. Disponible en: https://medicinafetalbarcelona.org/protocolos/es/patologia-materna-obstetrica/gestaci%C3%B3n%20ect%C3%B3HYPERLINK "https://medicinafetalbarcelona.org/protocolos/es/patologia-materna-obstetrica/gestación%20ectópica.pdf"pica.pdf. (Consulta: 20 diciembre 2020)
(15) Royal College of Obstetricians & Gynaecologists. Diagnosis and management of ectopic pregnancy: Green-top Guideline No. 21. BJOG 2016; 123(13):e15-e55. Doi: 10.1111/1471-0528.14189.
(16) American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins-Gynecology. ACOG Practice Bulletin No. 193: tubal ectopic pregnancy. Obstet Gynecol 2018; 131(3):e91-e103. doi: 10.1097/AOG. 0000000000002560.
(17) Kim J, Jung Y, Lee D, Jee B. Pretreatment serum human chorionic gonadotropin cutoff value for medical treatment success with single-dose and multi-dose regimen of methotrexate in tubal ectopic pregnancy. Obstet Gynecol Sci 2017; 60(1):79-86. doi: 10.5468/ogs.2017.60.1.79.
(18) Marret H, Fauconnier A, Dubernard G, Misme H, Lagarce L, Lesavre M, et al. Overview and guidelines of off-label use of methotrexate in ectopic pregnancy: report by CNGOF. Eur J Obstet Gynecol Reprod Biol 2016; 205:105-9. doi: 10.1016/j.ejogrb.2016.07.489.
(19) Yang C, Cai J, Geng Y, Gao Y. Multiple-dose and double-dose versus single-dose administration of methotrexate for the treatment of ectopic pregnancy: a systematic review and meta-analysis. Reprod Biomed Online 2017; 34(4):383-91. doi: 10.1016/j.rbmo.2017.01.004.
(20) Guvendag Guven E, Dilbaz S, Dilbaz B, Aykan Yildirim B, Akdag D, Haberal A. Comparison of single and multiple dose methotrexate therapy for unruptured tubal ectopic pregnancy: a prospective randomized study. Acta Obstet Gynecol Scand 2010; 89(7):889-95. doi: 10.3109/00016349. 2010.486825.
(21) Farquhar C. Ectopic pregnancy. Lancet 2005; 366(9485):583-91. doi: 10.1016/S0140-6736(05)67103-6.
(22) Graczykowski J, Mishell DJr. 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.
(23) Panelli D, Phillips C, Brady P. Incidence, diagnosis and management of tubal and nontubal ectopic pregnancies: a review. Fertil Res Pract 2015; 1:15. doi: 10.1186/s40738- 015-0008-z.
(24) Bonin L, Pedreiro C, Moret S, Chene G, Gaucherand P, Lamblin G. Predictive factors for the methotrexate treatment outcome in ectopic pregnancy: A comparative study of 400 cases. Eur J Obstet Gynecol Reprod Biol 2017; 208:23-30. doi: 10.1016/j.ejogrb.2016.11.016.
(25) Bueno F, Sáez J, Ocaranza M, Conejeros C, Vaccarezza I, Borquez P, et al. Tratamiento médico del embarazo ectópico. Rev Chil Obstet Ginecol 2002; 67(3):173-79. doi: 10.4067/s0717-75262002000300001.
(26) Leoni C, García F, López M, Pintos S, Rezzano R, Lijtenstein M, et al. Tratamiento médico del embarazo ectópico no complicado. Experiencia con el empleo de metotrexate. En: Sociedad Ginecotológica del Uruguay. XIII Congreso Uruguayo de Ginecotología; 2001 mayo 10-12; Montevideo, Uruguay.
(27) Hsu J, Chen L, Gumer A, Tergas A, Hou J, Burke W, et al. Disparities in the management of ectopic pregnancy. Am J Obstet Gynecol 2017; 217(1):49.e1-49.e10. doi: 10.1016/ j.ajog.2017.03.001.
(28) Furlong L. Ectopic pregnancy risk when contraception fails. A review. J Reprod Med 2002; 47(11):881-5.
(29) Dai Y, Zhang G, Zhu L, Lang J, Liu Z. Routine b-Human Chorionic Gonadotropin Monitoring for Single-Dose Methotrexate Treatment in Ectopic Pregnancy. J Minim Invasive Gynecol 2017; 24(7):1195-9. doi: 10.1016/j.jmig.2017. 07. 025.
(30) Sowter M, Farquhar C, Petrie K, Gudex G. A randomised trial comparing single dose systemic methotrexate and laparoscopic surgery for the treatment of unruptured tubal pregnancy. BJOG 2001; 108(2):192-203. doi: 10.1111 /j.1471- 0528.2001.00038.x.
(31) Fernández H, Capmas P, Lucot J, Resch B, Panel P, Bouyer J. Fertility after ectopic pregnancy: the DEMETER randomized trial. Hum Reprod 2013; 28(5):1247-53. doi: 10.1093/humrep/det037.
(2) Centers for Disease Control and Prevention. Ectopic pregnancy mortality - Florida, 2009-2010. MMWR Morb Mortal Wkly Rep 2012; 61(6):106-9. Disponible en: https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6106a2.htm. (Consulta: 17 junio 2020).
(3) Salvador Alarcón C, Callejo Olmos J, Laílla Vicens J. Embarazo ectópico. En: González Merlo J, Laílla Vicens J, Fabre González E, González Bosquet E. Obstetricia. 6 ed. Barcelona: Elsevier, 2013:331-45.
(4) Mol F, Mol B, Ankum W, van der Veen F, Hajenius P. Current evidence on surgery, systemic methotrexate and expectant management in the treatment of tubal ectopic pregnancy: a systematic review and meta-analysis. Hum Reprod Update 2008; 14(4):309-19. doi: 10.1093/humupd/dmn012.
(5) Embarazo ectópico. En: Fescina R, De Mucio B, Ortiz E, Jarquin D. Guías para la atención de las principales emergencias obstétricas. Publicación científica CLAP/SMR 1594. Montevideo: CLAP/SMR, 2012:25-32. Disponible en: http://www.paho.org/clap/index.php?option=com_docmanHYPERLINK "http://www.paho.org/clap/index.php?option=com_docman&view=download&category_slug=salud-de-mujer-reproductiva-materna-y-perinatal&alias=279-guias-para-la-atencion-de-las-principales-emergencias-obstetricas-1&Itemid=219&lang=es"&HYPERLINK "http://www.paho.org/clap/index.php?option=com_docman&view=download&category_slug=salud-de-mujer-reproductiva-materna-y-perinatal&alias=279-guias-para-la-atencion-de-las-principales-emergencias-obstetricas-1&Itemid=219&lang=es"view=downloadHYPERLINK "http://www.paho.org/clap/index.php?option=com_docman&view=download&category_slug=salud-de-mujer-reproductiva-materna-y-perinatal&alias=279-guias-para-la-atencion-de-las-principales-emergencias-obstetricas-1&Itemid=219&lang=es"&HYPERLINK "http://www.paho.org/clap/index.php?option=com_docman&view=download&category_slug=salud-de-mujer-reproductiva-materna-y-perinatal&alias=279-guias-para-la-atencion-de-las-principales-emergencias-obstetricas-1&Itemid=219&lang=es"category_slug=salud-de-mujer-reproductiva-materna-y-HYPERLINK "http://www.paho.org/clap/index.php?option=com_docman&view=download&category_slug=salud-de-mujer-reproductiva-materna-y-perinatal&alias=279-guias-para-la-atencion-de-las-principales-emergencias-obstetricas-1&Itemid=219&lang=es"perinatalHYPERLINK "http://www.paho.org/clap/index.php?option=com_docman&view=download&category_slug=salud-de-mujer-reproductiva-materna-y-perinatal&alias=279-guias-para-la-atencion-de-las-principales-emergencias-obstetricas-1&Itemid=219&lang=es"&HYPERLINK "http://www.paho.org/clap/index.php?option=com_docman&view=download&category_slug=salud-de-mujer-reproductiva-materna-y-perinatal&alias=279-guias-para-la-atencion-de-las-principales-emergencias-obstetricas-1&Itemid=219&lang=es"alias=279-guias-para-la-atencion-de-las-principales-emergencias-obstetricas-1HYPERLINK "http://www.paho.org/clap/index.php?option=com_docman&view=download&category_slug=salud-de-mujer-reproductiva-materna-y-perinatal&alias=279-guias-para-la-atencion-de-las-principales-emergencias-obstetricas-1&Itemid=219&lang=es"&HYPERLINK "http://www.paho.org/clap/index.php?option=com_docman&view=download&category_slug=salud-de-mujer-reproductiva-materna-y-perinatal&alias=279-guias-para-la-atencion-de-las-principales-emergencias-obstetricas-1&Itemid=219&lang=es"Itemid=219HYPERLINK "http://www.paho.org/clap/index.php?option=com_docman&view=download&category_slug=salud-de-mujer-reproductiva-materna-y-perinatal&alias=279-guias-para-la-atencion-de-las-principales-emergencias-obstetricas-1&Itemid=219&lang=es"&HYPERLINK "http://www.paho.org/clap/index.php?option=com_docman&view=download&category_slug=salud-de-mujer-reproductiva-materna-y-perinatal&alias=279-guias-para-la-atencion-de-las-principales-emergencias-obstetricas-1&Itemid=219&lang=es"lang=es. (Consulta: 17 junio 2020).
(6) Mallick R, Odejinmi F, Clark T. Covid 19 pandemic and gynaecological laparoscopic surgery: knowns and unknowns. Facts Views Vis Obgyn 2020; 12(1):1-5. Disponible en: https://mk0britishsociep8d9m.kinstacdn.HYPERLINK "https://mk0britishsociep8d9m.kinstacdn.com/wp-content/uploads/2020/04/Covid-19-pandemic-and-gynaecological-laparoscopic-surgery-knowns-and-unknowns.pdf"com/wp-content/uploads/2020/04/Covid-19-pandemic-and-gynaecological-laparoscopic-surgery-knowns-and-unknowns.pdf (Consulta: 17 junio 2020).
(7) Ramanah R, Marguier I, Mottet N, Magnin C, Riethmuller D. Embarazo extrauterino. EMC Ginecol Obstetr 2018; 54(3):1-14. doi: 10.1016/S1283-081X(18)91440-2.
(8) Sociedad Española de Ginecología y Obstetricia. Embarazo ectópico. Prog Obstet Ginecol 2007; 50(6):377-85. Disponible en: http://www.elsevier.es/es-revista-progresos-obstetricia-ginecologia-151-pdf-13106416-S300. (Consulta: enero 2017).
(9) Casas M, Sánchez J. Consideraciones éticas sobre el uso de metotrexate en el embarazo tubario (ET). Acta Bioeth 2012; 18(2):147-53. Disponible en: https://scielo.conicyt.cl/scielo.php?script=sci_arttextHYPERLINK "https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S1726-569X2012000200002"&HYPERLINK "https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S1726-569X2012000200002"pid=S1726-569X2012000200002. (Consulta: 17 junio 2020).
(10) Ruiz-Velasco V. Manejo actual del embarazo ectópico en la paciente estéril y en la que se desea conservar su fertilidad futura: actualización, Prog Obstet Ginecol 2010; 53(9):351-63. doi:10.1016/j.pog.2010.04.001.
(11) Song T, Kim M, Kim M, Jung Y, Yun B, Seong S. Single-dose versus two-dose administration of methotrexate for the treatment of ectopic pregnancy: a randomized controlled trial. Hum Reprod 2016; 31(2):332-8. doi: 10.1093/humrep/dev312.
(12) Practice Committee of American Society for Reproductive Medicine. Medical treatment of ectopic pregnancy: a committee opinion. Fertil Steril 2013; 100(3):638-44. doi: 10.1016/j.fertnstert.2013.06.013.
(13) Sánchez-Hidalgo L, López de la Manzanara C, Alpuente A, Garrido R, Sánchez- Hipólito L, González-López A. Evaluación del tratamiento médico del embarazo ectópico con metotrexato, Clin Invest Gin Obst 2012; 39(6):249-52. Disponible en: https://vdocuments.sitHYPERLINK "https://vdocuments.site/evaluacion-del-tratamiento-medico-del-embarazo-ectopico-con-metotrexato.html"e/evaluacion-del-tratamiento-medico-del-embarazo-ectopico-con-metotrexato.html. (Consulta: 17 junio 2020).
(14) Centre de Medicina Fetal i Neonatal de Barcelona. Protocolo: gestación ectópica tubárica y no tubárica. Barcelona: Hospital Clínic, Universitat de Barcelona, 2018. Disponible en: https://medicinafetalbarcelona.org/protocolos/es/patologia-materna-obstetrica/gestaci%C3%B3n%20ect%C3%B3HYPERLINK "https://medicinafetalbarcelona.org/protocolos/es/patologia-materna-obstetrica/gestación%20ectópica.pdf"pica.pdf. (Consulta: 20 diciembre 2020)
(15) Royal College of Obstetricians & Gynaecologists. Diagnosis and management of ectopic pregnancy: Green-top Guideline No. 21. BJOG 2016; 123(13):e15-e55. Doi: 10.1111/1471-0528.14189.
(16) American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins-Gynecology. ACOG Practice Bulletin No. 193: tubal ectopic pregnancy. Obstet Gynecol 2018; 131(3):e91-e103. doi: 10.1097/AOG. 0000000000002560.
(17) Kim J, Jung Y, Lee D, Jee B. Pretreatment serum human chorionic gonadotropin cutoff value for medical treatment success with single-dose and multi-dose regimen of methotrexate in tubal ectopic pregnancy. Obstet Gynecol Sci 2017; 60(1):79-86. doi: 10.5468/ogs.2017.60.1.79.
(18) Marret H, Fauconnier A, Dubernard G, Misme H, Lagarce L, Lesavre M, et al. Overview and guidelines of off-label use of methotrexate in ectopic pregnancy: report by CNGOF. Eur J Obstet Gynecol Reprod Biol 2016; 205:105-9. doi: 10.1016/j.ejogrb.2016.07.489.
(19) Yang C, Cai J, Geng Y, Gao Y. Multiple-dose and double-dose versus single-dose administration of methotrexate for the treatment of ectopic pregnancy: a systematic review and meta-analysis. Reprod Biomed Online 2017; 34(4):383-91. doi: 10.1016/j.rbmo.2017.01.004.
(20) Guvendag Guven E, Dilbaz S, Dilbaz B, Aykan Yildirim B, Akdag D, Haberal A. Comparison of single and multiple dose methotrexate therapy for unruptured tubal ectopic pregnancy: a prospective randomized study. Acta Obstet Gynecol Scand 2010; 89(7):889-95. doi: 10.3109/00016349. 2010.486825.
(21) Farquhar C. Ectopic pregnancy. Lancet 2005; 366(9485):583-91. doi: 10.1016/S0140-6736(05)67103-6.
(22) Graczykowski J, Mishell DJr. 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.
(23) Panelli D, Phillips C, Brady P. Incidence, diagnosis and management of tubal and nontubal ectopic pregnancies: a review. Fertil Res Pract 2015; 1:15. doi: 10.1186/s40738- 015-0008-z.
(24) Bonin L, Pedreiro C, Moret S, Chene G, Gaucherand P, Lamblin G. Predictive factors for the methotrexate treatment outcome in ectopic pregnancy: A comparative study of 400 cases. Eur J Obstet Gynecol Reprod Biol 2017; 208:23-30. doi: 10.1016/j.ejogrb.2016.11.016.
(25) Bueno F, Sáez J, Ocaranza M, Conejeros C, Vaccarezza I, Borquez P, et al. Tratamiento médico del embarazo ectópico. Rev Chil Obstet Ginecol 2002; 67(3):173-79. doi: 10.4067/s0717-75262002000300001.
(26) Leoni C, García F, López M, Pintos S, Rezzano R, Lijtenstein M, et al. Tratamiento médico del embarazo ectópico no complicado. Experiencia con el empleo de metotrexate. En: Sociedad Ginecotológica del Uruguay. XIII Congreso Uruguayo de Ginecotología; 2001 mayo 10-12; Montevideo, Uruguay.
(27) Hsu J, Chen L, Gumer A, Tergas A, Hou J, Burke W, et al. Disparities in the management of ectopic pregnancy. Am J Obstet Gynecol 2017; 217(1):49.e1-49.e10. doi: 10.1016/ j.ajog.2017.03.001.
(28) Furlong L. Ectopic pregnancy risk when contraception fails. A review. J Reprod Med 2002; 47(11):881-5.
(29) Dai Y, Zhang G, Zhu L, Lang J, Liu Z. Routine b-Human Chorionic Gonadotropin Monitoring for Single-Dose Methotrexate Treatment in Ectopic Pregnancy. J Minim Invasive Gynecol 2017; 24(7):1195-9. doi: 10.1016/j.jmig.2017. 07. 025.
(30) Sowter M, Farquhar C, Petrie K, Gudex G. A randomised trial comparing single dose systemic methotrexate and laparoscopic surgery for the treatment of unruptured tubal pregnancy. BJOG 2001; 108(2):192-203. doi: 10.1111 /j.1471- 0528.2001.00038.x.
(31) Fernández H, Capmas P, Lucot J, Resch B, Panel P, Bouyer J. Fertility after ectopic pregnancy: the DEMETER randomized trial. Hum Reprod 2013; 28(5):1247-53. doi: 10.1093/humrep/det037.
Published
2021-03-31
How to Cite
1.
Guzzo V, Ben S, Sica N. Four-year experience in medical treatment of ectopic pregnancy in the department of Paysandú. Rev. Méd. Urug. [Internet]. 2021Mar.31 [cited 2024Dec.26];37(1):e37102. Available from: http://www2.rmu.org.uy/ojsrmu311/index.php/rmu/article/view/670
Section
Original Articles
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