Open AccessUltrasound check of conservative treatment with methotrexate in ectopic pregnancy
Author(s) -
Cătălina Diana Stănică,
Bucureşti Universitatea de Medicină și Farmacie „Carol Davila“,
Adrian Neacşu,
Constantin Dimitrie Nanu,
Oneaga Gabriela,
Bucureşti Maternitatea „Polizu“
Publication year - 2016
Publication title -
romanian medical journal
Language(s) - English
Resource type - Journals
eISSN - 2069-606X
pISSN - 1220-5478
DOI - 10.37897/rmj.2016.4.15
Subject(s) - medicine , methotrexate , ectopic pregnancy , pregnancy , decompensation , ultrasound , obstetrics , conservative treatment , gynecology , surgery , radiology , genetics , biology
Ectopic pregnancy (EP) remains a significant cause of maternal death (2nd cause of maternal death in the US – 3.5‰ women in 1970, 0.5‰ in 1987, with the downward trend 0.20‰). Early diagnosis allows initiation of conservative medical therapy with methotrexate. During the diagnosis of EP with the possibility of medication, we used an algorithm which has particularly chosen the cases with uncomplicated EP showing no contraindications to treatment with methotrexate. Monitoring the treatment with methotrexate, we chose as main element β-hCG serum dosage, followed by ultrasound monitoring that allows early diagnosis of EP, favoring the preservation of fertility and decreasing the risk of relapse. Ultrasound monitoring envisaged the exclusion of an intrauterine pregnancy, the differential diagnosis of intrauterine false ovular sac images or early pregnancy, the confirmation or invalidation of annexed ovular sac with or without embryonic elements. Also, the ultrasound has enabled the evaluation of complications by identifying fluid in Douglas space, vesico-ureteral uterine space, enabling early decision making for surgery, thus avoiding hemodynamic decompensation of patients. The lowest initial level of serum β-hCG is, the more important the success rate is.