Medical Treatment of Undisturbed Ectopic Pregnancy in Minia Maternity University Hospital a Randomized Controlled Study | ||||
| Minia Journal of Medical Research | ||||
| Volume 31, Issue 1, January 2020, Page 140-149 PDF (498.28 K) | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/mjmr.2022.221489 | ||||
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| Authors | ||||
| Kamal El-Deen Abd El-Hameed; Ahmed R. Abd El-Reheim; Ahmed H. Ahmed | ||||
| Department of Obstetrics & Gynecology, El-Minia Faculty of Medicine | ||||
| Abstract | ||||
| Background: Ectopic pregnancy, a high-risk condition in which a fertilized ovum implants outside the uterine cavity, affects 1% to 2% of all pregnancies and poses a significant threat to women of reproductive age. It is the leading cause of maternal death during the first trimester of pregnancy and is responsible for 9% of pregnancy-related deaths in the United States (Creanga et al., 2011). Clinicians should consider the diagnosis of ectopic pregnancy in any woman in the first trimester of pregnancy that has abdominal or pelvic pain, vaginal bleeding or both (ACOG, 2009). After a definitive diagnosis has been made, treatment options include medical, surgical, or expectant management (Hajenius et al., 2007). Aim of the work: The aim of our study was to evaluate the efficacy and safety of medical treatment of undisturbed ectopic pregnancy either by Methotrexate, or by Aromatase inhibitors "Letrozole" in comparison to laparoscopic treatment for the same purpose in well selected cases of undisturbed ectopic pregnancy at Minia Maternity University Hospital during period from January 2018 to December 2018. Patients and Methods: 400 candidates for the study were diagnosed with ectopic pregnancy either through the outpatient clinics or admitted through the emergency department. These candidates were subjected to full work up. Following this workup, only 200 candidates were diagnosed with undisturbed ectopic pregnancy. From these 200 cases of undisturbed ectopic pregnancy 34 cases of them were eligible to be in our study according our strict inclusion criteria: These 34 cases which fulfilled our inclusion criteria were randomized by closed sealed envelopes into 3 groups: Group Ι (Laparoscopy group) It included 10 patients, who had laparoscopic salpingostomy as a first line of treatment for undisturbed ectopic pregnancy. Group ΙΙ (Methotrexate group): It included 10 patients, who had given a single dose of Methotrexate (1 mg/kg IM in a single injection) as a first line of treatment for undisturbed ectopic. Group ΙΙΙ (Letrozole group): It included 14 patients, who had given Letrozole 2.5mg, in combination with Norethisterone 5 mg as an adjuvant therapy for 10 days both twice daily as a first line of treatment for undisturbed ectopic. Results: The Success rate of the first line of treatment in each group and it was in laparoscopy group (90%), methotrexate group was (80%) and in Letrozole group was (78.6%), therefore the Letrozole can be used in the treatment of undisturbed ectopic in well selected cases. Conclusion: Laparoscopy remains the gold standard first line modality for diagnosis and treatment of undisturbed ectopic pregnancy. It is also the modality of choice in case of failure of medical treatment. Medical treatment with methotrexate for undisturbed ectopic pregnancy has its definite role as an alternative to laparoscopy. Letrozole has the advantage of easy administration and high safety profile when compared to methotrexate and laparoscopy | ||||
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