Research Article
PDF EndNote BibTex RIS Cite

The Importance of Hemoperitoneum and Retrospective Analysis of Tubal Ectopic Pregnancy Cases Treated in our Clinic

Year 2022, Volume 4, Issue 3, 135 - 140, 10.11.2022
https://doi.org/10.38175/phnx.1165623

Abstract

Aim: The purpose of this study is to present the importance of hemoperitoneum and retrospective analysis of tubal ectopic pregnancy cases treated in our clinic. Material and Methods: This study respectively included 86 women who were diagnosed and treated for tubal ectopic pregnancy (EP) in our single-centre clinic between January 2012 and August 2013. Age, date of last menstrual period, human chorionic gonadotropin (β-hCG) level, the size and the presence of tubal EP masses, fetal cardiac activity and treatment procedures were evaluated and compared. The presence of hemoperitoneum for predictive treatment methods and factors that affecting the success of treatment methods were investigated. Results: The mean age of the patients was 29.1±5.7 (16-41) years. Mean β-hCG level was 4448,5±8351,9 IU/L. Laparatomy was performed to 14 patients (16.3%), laparoscopy to 5 patients (5.8%), expectant management to 15 patients (17.4%). Methotrexate (MTX) treatment was given to 46 patients (53.5%) and laparoscopy was performed to 1 patient (1.2%) and laparatomy to 5 patients (5.8%) due to MTX treatment failure in 6 patients. Compared with the MTX treatment of tubal EP, the possible factors that affecting surgical management, such as the initial β-hCG level (p=0.004), whether there is hemorrhage in the abdominal cavity (p=0.03), the size of ectopic pregnancy mass (p=.005) and the presence of fetal heart activity (p<0.001) were found to be statistically significant. The success rate single-dose MTX treatment was 69.5%. Conclusion: The presence of hemoperitoneum in treatment methods may be a risk factor for MTX treatment, leading to surgical treatment. MTX treatment is one of alternative method to surgical treatment in tubal EP.

References

  • Marion LL, Meeks GR. Ectopic pregnancy: History, incidence, epidemiology, and risk factors. Clin Obstet Gynecol. 2012;55(2):376-86.
  • Cunningham FG LK, Bloom SL. Williams Obstetrics. McGraw-Hill (23 edn) New York; 2010.
  • Bonin L PC, 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.
  • Vermesh M GJ, Sauer MV. Reevaluation of the role of culdocentesis in the management of ectopic pregnancy. Am J Obstet Gynecol. 1990;162(2):411-3.
  • DiMarchi JM KT, Hale RW. What is the significance of the human chorionic gonadotropin value in ectopic pregnancy? Obstet Gynecol. 1989;74(6):851-5.
  • Frates MC, Brown DL, Doubilet PM, Hornstein MD. Tubal rupture in patients with ectopic pregnancy: diagnosis with transvaginal US. Radiology. 1994;191(3):769-72.
  • Mol BW, Hajenius PJ, Engelsbel S, Ankum WM, van der Veen F, Hemrika DJ, et al. Can noninvasive diagnostic tools predict tubal rupture or active bleeding in patients with tubal pregnancy? Fertil Steril. 1999;71(1):167-73.
  • Chang J, Elam-Evans LD, Berg CJ, Herndon J, Flowers L, Seed KA, et al. Pregnancy-related mortality surveillance--United States, 1991--1999. MMWR Surveill Summ. 2003;52(2):1-8.
  • Lipscomb GH, McCord ML, Stovall TG, Huff G, Portera SG, Ling FW. Predictors of success of methotrexate treatment in women with tubal ectopic pregnancies. N Engl J Med. 1999;341(26):1974-8.
  • Potter MB, Lepine LA, Jamieson DJ. Predictors of success with methotrexate treatment of tubal ectopic pregnancy at Grady Memorial Hospital. Am J Obstet Gynecol. 2003;188(5):1192-4.
  • van Mello NM, Mol F, Opmeer BC, Ankum WM, Barnhart K, Coomarasamy A et, al. Diagnostic value of serum hCG on the outcome of pregnancy of unknown location: a systematic review and meta-analysis. Hum Reprod Update. 2012;18(6):603-17.
  • Bignardi T, Condous G. Does tubal ectopic pregnancy with hemoperitoneum always require surgery? Ultrasound Obstet Gynecol. 2009;33(6):711-5.
  • Capmas P, Bouyer J, Fernandez H. Treatment of ectopic pregnancies in 2014: new answers to some old questions. Fertil Steril. 2014;101(3):615-20.
  • Cecchino GN, Araujo Júnior E, Elito Júnior J. Methotrexate for ectopic pregnancy: when and how. Arch Gynecol Obstet. 2014;290(3):417-23.
  • Lesavre M, Curinier S, Capmas P, Rabischong B, Fernandez H. Utilisation du méthotrexate dans les GEU tubaires [Treatment of tubal ectopic pregnancy by methotrexate]. J Gynecol Obstet Biol Reprod (Paris). 2015;44(3):212-9.
  • Beguin C, Brichant G, De Landsheere L, Tebache L, Karampelas S, Seidel L, et al. Use of methotrexate in the treatment of ectopic pregnancies: a retrospective single center study. Facts Views Vis Obgyn. 2020;11(4):329-335.
  • Practice Committee of American Society for Reproductive Medicine. Medical treatment of ectopic pregnancy. Fertil Steril. 2008;90(5 Suppl):206-12.
  • Kirk E, Daemen A, Papageorghiou AT, Bottomley C, Condous G, De Moor B, et al. Why are some ectopic pregnancies characterized as pregnancies of unknown location at the initial transvaginal ultrasound examination? Acta Obstet Gynecol Scand. 2008;87(11):1150-4.
  • Sickler GK CP, Dubinsky TJ, Maklad N. Free echogenic pelvic fluid: correlation with hemoperitoneum. J Ultrasound Med. 1998;17(7):431-5.
  • Barnhart KT. Clinical practice. Ectopic pregnancy. N Engl J Med. 2009;361(4):379-87.
  • Tanaka T, Hayashi H, Kutsuzawa T, Fujimoto S, Ichinoe K. Treatment of interstitial ectopic pregnancy with methotrexate: report of a successful case. Fertil Steril. 1982;37(6):851-2.
  • Condous G, Okaro E, Khalid A, Lu C, Van Huffel S, Timmerman D, et al. The accuracy of transvaginal ultrasonography for the diagnosis of ectopic pregnancy prior to surgery. Hum Reprod. 2005;20(5):1404-9.
  • Bleyer WA. The clinical pharmacology of methotrexate: new applications of an old drug. Cancer. 1978;41(1):36-51. .
  • Helmy S, Bader Y, Pablik E, Tiringer D, Pils S, Laml T, et al. Cut-off value of initial serum β-hCG level predicting a successful MTX therapy in tubal ectopic pregnancy: a retrospective cohort study. Eur J Obstet Gynecol Reprod Biol. 2014;179:175-80. .
  • Sargin MA, Yassa M, Taymur BD, Çelik A, Aydin S, Orhan E, et al. A Clinical Experience of Ectopic Pregnancies with Initial Free Intraperitoneal Fluid. J Clin Diagn Res. 2016;10(8):QC22-6.
  • Orozco EM, Sánchez-Durán MA, Bello-Muñoz JC, Sagalá J, Carreras E, Roura LC. ß-hCG and prediction of therapeutic success in ectopic pregnancies treated with methotrexate, results from a prospective observational study. J Matern Fetal Neonatal Med. 2015;28(6):695-9.
  • Gingold JA, Janmey I, Gemmell L, Mei L, Falcone T. Effect of Methotrexate on Salpingostomy Completion Rate for Tubal Ectopic Pregnancy: A Retrospective Cohort Study. J Minim Invasive Gynecol. 2021;28(7):1334-1342.e3.
  • 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.
  • Levin G, Dior U, Shushan A, Gilad R, Benshushan A, Rottenstreich A. Early prediction of the success of methotrexate treatment success by 24-hour pretreatment increment in HCG and day 1-4 change in HCG. Reprod Biomed Online. 2019;39(1):149-154. .
  • Barbier M, Pivano A, Tourette C, Poizac S, Cravello L, Boubli L, et al. Evaluation of a follow-up customized strategy for women treated with methotrexate for an ectopic pregnancy: An observational study. Eur J Obstet Gynecol Reprod Biol. 2019;236:32-35.
  • Sindiani AM, Alshdaifat E, Obeidat B, Obeidat R, Rawashdeh H, Yaseen H. The Use of Single Dose Methotrexate in the Management of Ectopic Pregnancy and Pregnancy of Unknown Location: 10 Years’ Experience in a Tertiary Center. Int J Womens Health. 2020;12:1233-1239.

Kliniğimizde Tedavi Edilen Tubal Ektopik Gebelik Olgularında Hemoperitonyumun Önemi ve Retrospektif Analizi

Year 2022, Volume 4, Issue 3, 135 - 140, 10.11.2022
https://doi.org/10.38175/phnx.1165623

Abstract

Amaç: Bu çalışmanın amacı kliniğimizde tedavi edilen tubal ektopik gebelik olgularının hemoperitonyumun önemini ve retrospektif analizini sunmaktır. Gereç ve Yöntemler: Bu çalışmaya Ocak 2012 ile Ağustos 2013 tarihleri arasında tek merkezli kliniğimizde tubal ektopik gebelik (EP) tanısı ve tedavisi konulan 86 kadın dahil edildi. Yaş, son adet tarihi, insan koryonik gonadotropin (β-hCG) ) düzeyi, tubal EP kitlelerinin büyüklüğü ve varlığı, fetal kardiyak aktivite ve tedavi prosedürleri değerlendirildi ve karşılaştırıldı. Prediktif tedavi yöntemleri için hemoperiton varlığı ve tedavi yöntemlerinin başarısını etkileyen faktörler araştırıldı. Bulgular: olguların yaş ortalaması 29,1±5,7 (16-41) yıl idi. Ortalama β-hCG düzeyi 4448,5±8351,9 IU/L idi. 14 olguya (%16.3) laparatomi, 5 olguya (%5.8) laparoskopi, 15 olguya (%17.4) ekspektan tedavi uygulandı. MTX tedavisi başarısızlığı nedeniyle 46 olguya (%53,5) metotreksat (MTX) tedavisi, 1 olguya (%1,2) laparoskopi, 5 olguya (%5,8) laparatomi uygulandı. Tubal EP'nin MTX tedavisi ile karşılaştırıldığında, başlangıç β-hCG düzeyi (p=0,004), intraabdominal kanama olup olmadığı (p=0,03), ektopik gebelik boyutu (p=0,005) ve fetal kalp aktivitesinin varlığı (p<0,001) gibi cerrahi yönetimi etkileyen olası faktörler istatistiksel olarak anlamlı bulundu. Tek doz MTX tedavisinin başarı oranı %69.5 idi. Sonuç: Tedavi yöntemlerinde hemoperitonyumun varlığı MTX tedavisi için cerrahi tedaviye yol açan bir risk faktörü olabilir. MTX tedavisi tubal EP'de cerrahi tedaviye alternatif yöntemlerden biridir.

References

  • Marion LL, Meeks GR. Ectopic pregnancy: History, incidence, epidemiology, and risk factors. Clin Obstet Gynecol. 2012;55(2):376-86.
  • Cunningham FG LK, Bloom SL. Williams Obstetrics. McGraw-Hill (23 edn) New York; 2010.
  • Bonin L PC, 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.
  • Vermesh M GJ, Sauer MV. Reevaluation of the role of culdocentesis in the management of ectopic pregnancy. Am J Obstet Gynecol. 1990;162(2):411-3.
  • DiMarchi JM KT, Hale RW. What is the significance of the human chorionic gonadotropin value in ectopic pregnancy? Obstet Gynecol. 1989;74(6):851-5.
  • Frates MC, Brown DL, Doubilet PM, Hornstein MD. Tubal rupture in patients with ectopic pregnancy: diagnosis with transvaginal US. Radiology. 1994;191(3):769-72.
  • Mol BW, Hajenius PJ, Engelsbel S, Ankum WM, van der Veen F, Hemrika DJ, et al. Can noninvasive diagnostic tools predict tubal rupture or active bleeding in patients with tubal pregnancy? Fertil Steril. 1999;71(1):167-73.
  • Chang J, Elam-Evans LD, Berg CJ, Herndon J, Flowers L, Seed KA, et al. Pregnancy-related mortality surveillance--United States, 1991--1999. MMWR Surveill Summ. 2003;52(2):1-8.
  • Lipscomb GH, McCord ML, Stovall TG, Huff G, Portera SG, Ling FW. Predictors of success of methotrexate treatment in women with tubal ectopic pregnancies. N Engl J Med. 1999;341(26):1974-8.
  • Potter MB, Lepine LA, Jamieson DJ. Predictors of success with methotrexate treatment of tubal ectopic pregnancy at Grady Memorial Hospital. Am J Obstet Gynecol. 2003;188(5):1192-4.
  • van Mello NM, Mol F, Opmeer BC, Ankum WM, Barnhart K, Coomarasamy A et, al. Diagnostic value of serum hCG on the outcome of pregnancy of unknown location: a systematic review and meta-analysis. Hum Reprod Update. 2012;18(6):603-17.
  • Bignardi T, Condous G. Does tubal ectopic pregnancy with hemoperitoneum always require surgery? Ultrasound Obstet Gynecol. 2009;33(6):711-5.
  • Capmas P, Bouyer J, Fernandez H. Treatment of ectopic pregnancies in 2014: new answers to some old questions. Fertil Steril. 2014;101(3):615-20.
  • Cecchino GN, Araujo Júnior E, Elito Júnior J. Methotrexate for ectopic pregnancy: when and how. Arch Gynecol Obstet. 2014;290(3):417-23.
  • Lesavre M, Curinier S, Capmas P, Rabischong B, Fernandez H. Utilisation du méthotrexate dans les GEU tubaires [Treatment of tubal ectopic pregnancy by methotrexate]. J Gynecol Obstet Biol Reprod (Paris). 2015;44(3):212-9.
  • Beguin C, Brichant G, De Landsheere L, Tebache L, Karampelas S, Seidel L, et al. Use of methotrexate in the treatment of ectopic pregnancies: a retrospective single center study. Facts Views Vis Obgyn. 2020;11(4):329-335.
  • Practice Committee of American Society for Reproductive Medicine. Medical treatment of ectopic pregnancy. Fertil Steril. 2008;90(5 Suppl):206-12.
  • Kirk E, Daemen A, Papageorghiou AT, Bottomley C, Condous G, De Moor B, et al. Why are some ectopic pregnancies characterized as pregnancies of unknown location at the initial transvaginal ultrasound examination? Acta Obstet Gynecol Scand. 2008;87(11):1150-4.
  • Sickler GK CP, Dubinsky TJ, Maklad N. Free echogenic pelvic fluid: correlation with hemoperitoneum. J Ultrasound Med. 1998;17(7):431-5.
  • Barnhart KT. Clinical practice. Ectopic pregnancy. N Engl J Med. 2009;361(4):379-87.
  • Tanaka T, Hayashi H, Kutsuzawa T, Fujimoto S, Ichinoe K. Treatment of interstitial ectopic pregnancy with methotrexate: report of a successful case. Fertil Steril. 1982;37(6):851-2.
  • Condous G, Okaro E, Khalid A, Lu C, Van Huffel S, Timmerman D, et al. The accuracy of transvaginal ultrasonography for the diagnosis of ectopic pregnancy prior to surgery. Hum Reprod. 2005;20(5):1404-9.
  • Bleyer WA. The clinical pharmacology of methotrexate: new applications of an old drug. Cancer. 1978;41(1):36-51. .
  • Helmy S, Bader Y, Pablik E, Tiringer D, Pils S, Laml T, et al. Cut-off value of initial serum β-hCG level predicting a successful MTX therapy in tubal ectopic pregnancy: a retrospective cohort study. Eur J Obstet Gynecol Reprod Biol. 2014;179:175-80. .
  • Sargin MA, Yassa M, Taymur BD, Çelik A, Aydin S, Orhan E, et al. A Clinical Experience of Ectopic Pregnancies with Initial Free Intraperitoneal Fluid. J Clin Diagn Res. 2016;10(8):QC22-6.
  • Orozco EM, Sánchez-Durán MA, Bello-Muñoz JC, Sagalá J, Carreras E, Roura LC. ß-hCG and prediction of therapeutic success in ectopic pregnancies treated with methotrexate, results from a prospective observational study. J Matern Fetal Neonatal Med. 2015;28(6):695-9.
  • Gingold JA, Janmey I, Gemmell L, Mei L, Falcone T. Effect of Methotrexate on Salpingostomy Completion Rate for Tubal Ectopic Pregnancy: A Retrospective Cohort Study. J Minim Invasive Gynecol. 2021;28(7):1334-1342.e3.
  • 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.
  • Levin G, Dior U, Shushan A, Gilad R, Benshushan A, Rottenstreich A. Early prediction of the success of methotrexate treatment success by 24-hour pretreatment increment in HCG and day 1-4 change in HCG. Reprod Biomed Online. 2019;39(1):149-154. .
  • Barbier M, Pivano A, Tourette C, Poizac S, Cravello L, Boubli L, et al. Evaluation of a follow-up customized strategy for women treated with methotrexate for an ectopic pregnancy: An observational study. Eur J Obstet Gynecol Reprod Biol. 2019;236:32-35.
  • Sindiani AM, Alshdaifat E, Obeidat B, Obeidat R, Rawashdeh H, Yaseen H. The Use of Single Dose Methotrexate in the Management of Ectopic Pregnancy and Pregnancy of Unknown Location: 10 Years’ Experience in a Tertiary Center. Int J Womens Health. 2020;12:1233-1239.

Details

Primary Language English
Subjects Obstetrics and Gynecology
Journal Section Research Articles
Authors

Fazıl AVCI> (Primary Author)
SELÇUK ÜNİVERSİTESİ, TIP FAKÜLTESİ
0000-0002-9244-9168
Türkiye


Gürkan KIRAN>
KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNİVERSİTESİ, TIP FAKÜLTESİ
0000-0002-6300-328X
Türkiye


Hakan KIRAN>
KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNİVERSİTESİ, TIP FAKÜLTESİ
0000-0003-3032-5861
Türkiye


Salih SERİN>
KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNİVERSİTESİ, TIP FAKÜLTESİ
0000-0002-7333-754X
Türkiye

Supporting Institution Yok
Project Number yok
Thanks I would like to thank Deniz Cemgil Arıkan, Önder Ercan, Bülent Köstü and Murat Bakacak, who did not meet the authorship criteria.
Publication Date November 10, 2022
Submission Date August 22, 2022
Acceptance Date November 4, 2022
Published in Issue Year 2022, Volume 4Issue 3

Cite

AMA Avcı F. , Kıran G. , Kıran H. , Serin S. The Importance of Hemoperitoneum and Retrospective Analysis of Tubal Ectopic Pregnancy Cases Treated in our Clinic. Phnx Med J. 2022; 4(3): 135-140.

Creative Commons License
Phoenix Medical Journal is licensed under a Creative Commons Attribution 4.0 International License.

Our journal has adopted the Open Access Policy, and no fees will be charged from the authors at any stage of the publication for the articles submitted.