Expectant management Archives - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2020;42(12):800-804
In recent years, there has been an increase in the incidence of ectopic pregnancies; therefore, it is important for tertiary centers to report their approaches and outcomes to expand and improve treatment modalities. The aim of the present study was to evaluate the general characteristics, treatment and outcomes of cases diagnosed with ectopic pregnancy.
In total, 432 patients treated for ectopic pregnancy between February 2016 and June 2019 were retrospectively evaluated.
Overall, 370 patients had tubal pregnancy, 32 had cesarean scar pregnancy, 18 had pregnancy of unknown location, 6 had cervical pregnancy, and 6 had interstitial pregnancy. The most important risk factors were advanced age (> 35 years; prevalence: 31.2%) and smoking (prevalence: 27.1%). Thirty patients who did not have any symptoms of rupture and whose human chorionic gonadotropin (β-hCG) levels were ≤ 200 mIU/ml were followed-up with expectant management, while 316 patients whose β-hCG levels were between 1,500 mIU/ml and 5,000 mIU/ml did not have an intrauterine gestational sac on the transvaginal or abdominal ultrasound, did not demonstrate findings of rupture, and were treated with a systemic multi-dose methotrexate treatment protocol. In total, 24 patients who did not respond to the medical treatment, 20 patients whose β-hCG levels were > 5,000 mIU/ml, 16 patients who had shown symptoms of rupture at the initial presentation, and 6 patients diagnosed with interstitial pregnancy underwent surgery. Patients with cervical and scar pregnancies underwent ultrasound-guided curettage, and no additional treatment was needed.
The fertility status of the patients, the clinical and laboratory findings, and the levels of β-hCG are the factors that must be considered in planning the appropriate treatment.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2020;42(12):800-804
In recent years, there has been an increase in the incidence of ectopic pregnancies; therefore, it is important for tertiary centers to report their approaches and outcomes to expand and improve treatment modalities. The aim of the present study was to evaluate the general characteristics, treatment and outcomes of cases diagnosed with ectopic pregnancy.
In total, 432 patients treated for ectopic pregnancy between February 2016 and June 2019 were retrospectively evaluated.
Overall, 370 patients had tubal pregnancy, 32 had cesarean scar pregnancy, 18 had pregnancy of unknown location, 6 had cervical pregnancy, and 6 had interstitial pregnancy. The most important risk factors were advanced age (> 35 years; prevalence: 31.2%) and smoking (prevalence: 27.1%). Thirty patients who did not have any symptoms of rupture and whose human chorionic gonadotropin (β-hCG) levels were ≤ 200 mIU/ml were followed-up with expectant management, while 316 patients whose β-hCG levels were between 1,500 mIU/ml and 5,000 mIU/ml did not have an intrauterine gestational sac on the transvaginal or abdominal ultrasound, did not demonstrate findings of rupture, and were treated with a systemic multi-dose methotrexate treatment protocol. In total, 24 patients who did not respond to the medical treatment, 20 patients whose β-hCG levels were > 5,000 mIU/ml, 16 patients who had shown symptoms of rupture at the initial presentation, and 6 patients diagnosed with interstitial pregnancy underwent surgery. Patients with cervical and scar pregnancies underwent ultrasound-guided curettage, and no additional treatment was needed.
The fertility status of the patients, the clinical and laboratory findings, and the levels of β-hCG are the factors that must be considered in planning the appropriate treatment.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(8):465-470
DOI 10.1590/S0100-72031999000800007
SUMMARY Objective: to evaluate the inclusion parameters in the selection of cases of (tubal) ectopic pregnancy for expectant management and to assess the results. Methods: a prospective study was carried out in 70 patients with unruptured (tubal) ectopic pregnancy, with the objective to carry out an expectant management. The main inclusion criteria in this study were the diameter of the tubal mass, that should be equal or inferior to 5,0 cm, reduced titles of beta-hCG (beta fraction of the chorionic gonadotropic hormone) as compared to the initial value within an interval of 48 h, hemodynamic stability, wishes for future pregnancy and a written permission to participate in the study. All patients were observed in the hospital and when reduction in beta-hCG titles was observed, the patients were discharged from the hospital and followed in the outpatient department, with weekly determinations of beta-hCG until levels lower than 5 mIU/ml were reached, that were considered successful. Results: of the 70 patients who underwent expectant management, only one needed a surgical intervention, because of tubal rupture. The initial values of beta-hCG of the patients ranged from 27 mIU/ml to 41,000 mIU/ml. The average diameter of the tubal mass was 2.9 cm. The presence of free liquid in the peritoneal cavity was observed in 50 patients, small amount in 26 patients, moderate in 16 and large in 8 patients. The ultrasonographic resolution of hematosalpinx occurred in 58 patients and tubal ring was visualized in 12 patients. On color Doppler, 52 were at low risk and 18 at medium risk. Conclusions: the expectant management should be applied with safety in the cases that respect the inclusion criteria, the index of success of this study being 98.6%.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(8):465-470
DOI 10.1590/S0100-72031999000800007
SUMMARY Objective: to evaluate the inclusion parameters in the selection of cases of (tubal) ectopic pregnancy for expectant management and to assess the results. Methods: a prospective study was carried out in 70 patients with unruptured (tubal) ectopic pregnancy, with the objective to carry out an expectant management. The main inclusion criteria in this study were the diameter of the tubal mass, that should be equal or inferior to 5,0 cm, reduced titles of beta-hCG (beta fraction of the chorionic gonadotropic hormone) as compared to the initial value within an interval of 48 h, hemodynamic stability, wishes for future pregnancy and a written permission to participate in the study. All patients were observed in the hospital and when reduction in beta-hCG titles was observed, the patients were discharged from the hospital and followed in the outpatient department, with weekly determinations of beta-hCG until levels lower than 5 mIU/ml were reached, that were considered successful. Results: of the 70 patients who underwent expectant management, only one needed a surgical intervention, because of tubal rupture. The initial values of beta-hCG of the patients ranged from 27 mIU/ml to 41,000 mIU/ml. The average diameter of the tubal mass was 2.9 cm. The presence of free liquid in the peritoneal cavity was observed in 50 patients, small amount in 26 patients, moderate in 16 and large in 8 patients. The ultrasonographic resolution of hematosalpinx occurred in 58 patients and tubal ring was visualized in 12 patients. On color Doppler, 52 were at low risk and 18 at medium risk. Conclusions: the expectant management should be applied with safety in the cases that respect the inclusion criteria, the index of success of this study being 98.6%.
