Conservative treatment in non-tubal ectopic pregnancy and predictors of treatment failure
Nedopekina, Ekaterina LU ; Escura, Silvia ; Cobo, Teresa ; Hansson, Stefan Rocco LU
; Martinez, Josep Maria
; Figueras, Francesc
and López, Marta
(2021)
In European Journal of Obstetrics and Gynecology and Reproductive Biology
257.
p.6-10
- Abstract
Objectives: To find possible predictive factors to predict the failure of conservative treatment of non-tubal ectopic pregnancy. For that purpose, we assessed the rate of failure, complications and need for additional interventions of the different primary treatment regimens in non-tubal ectopic pregnancies that occurred in our center. Study design: Retrospective single-center study conducted at Hospital Clínic of Barcelona (Spain). Conservative treatment regimens included medical (systemic single or multiple dose methotrexate; ultrasound-guided intrasaccular injection of methotrexate or chloride potassium; surgical (oophorectomy in case of ovarian ectopic pregnancy, surgical curettage). The main outcome measures were success of primary... (More)
Objectives: To find possible predictive factors to predict the failure of conservative treatment of non-tubal ectopic pregnancy. For that purpose, we assessed the rate of failure, complications and need for additional interventions of the different primary treatment regimens in non-tubal ectopic pregnancies that occurred in our center. Study design: Retrospective single-center study conducted at Hospital Clínic of Barcelona (Spain). Conservative treatment regimens included medical (systemic single or multiple dose methotrexate; ultrasound-guided intrasaccular injection of methotrexate or chloride potassium; surgical (oophorectomy in case of ovarian ectopic pregnancy, surgical curettage). The main outcome measures were success of primary treatment and the need for additional interventions. The secondary outcomes were success rate of conservative treatment, incidence of complications, days to discharge from the hospital, days until negative β-hCG, days until complete resolution of the process. Possible predictor factors for primary treatment failure were assessed. Results: A total of 39 cases were included. Primary treatment was successful in 74 % (29/39). The rate of failure of primary treatment was higher in the group with presence of embryo heartbeat than in the group without, 46 % vs. 15 % respectively (p < 0.0001). Among the cases that required additional treatments, none of them required hysterectomy. Presence of embryo heartbeat significantly increased the likelihood of failure of the primary treatment (OR 4.71, 95 % CI 1.03–21.65, p < 0.05). Every doubling of the β-hCG levels increased the risk of treatment failure by 54 % (OR 1.54, 95 % CI 1.03–2.39, p < 0.05). Conclusions: Conservative treatment is a safe option for treatment of non-tubal ectopic pregnancy. The presence of embryo heartbeat and β-hCG levels at diagnosis may be used as predictive factors of failure of conservative treatment.
(Less)
- author
- Nedopekina, Ekaterina
LU
; Escura, Silvia
; Cobo, Teresa
; Hansson, Stefan Rocco
LU
; Martinez, Josep Maria
; Figueras, Francesc
and López, Marta
- organization
- publishing date
- 2021
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Conservative treatment, Failure of treatment, Intrasaccular injection, Non-tubal ectopic pregnancy
- in
- European Journal of Obstetrics and Gynecology and Reproductive Biology
- volume
- 257
- pages
- 5 pages
- publisher
- Elsevier
- external identifiers
-
- pmid:33310657
- scopus:85097450395
- ISSN
- 0301-2115
- DOI
- 10.1016/j.ejogrb.2020.11.067
- language
- English
- LU publication?
- yes
- id
- ecacb1f1-c62e-4ccd-83ef-c0eb08cc816b
- date added to LUP
- 2020-12-21 10:56:53
- date last changed
- 2024-05-01 22:42:03
@article{ecacb1f1-c62e-4ccd-83ef-c0eb08cc816b,
abstract = {{<p>Objectives: To find possible predictive factors to predict the failure of conservative treatment of non-tubal ectopic pregnancy. For that purpose, we assessed the rate of failure, complications and need for additional interventions of the different primary treatment regimens in non-tubal ectopic pregnancies that occurred in our center. Study design: Retrospective single-center study conducted at Hospital Clínic of Barcelona (Spain). Conservative treatment regimens included medical (systemic single or multiple dose methotrexate; ultrasound-guided intrasaccular injection of methotrexate or chloride potassium; surgical (oophorectomy in case of ovarian ectopic pregnancy, surgical curettage). The main outcome measures were success of primary treatment and the need for additional interventions. The secondary outcomes were success rate of conservative treatment, incidence of complications, days to discharge from the hospital, days until negative β-hCG, days until complete resolution of the process. Possible predictor factors for primary treatment failure were assessed. Results: A total of 39 cases were included. Primary treatment was successful in 74 % (29/39). The rate of failure of primary treatment was higher in the group with presence of embryo heartbeat than in the group without, 46 % vs. 15 % respectively (p < 0.0001). Among the cases that required additional treatments, none of them required hysterectomy. Presence of embryo heartbeat significantly increased the likelihood of failure of the primary treatment (OR 4.71, 95 % CI 1.03–21.65, p < 0.05). Every doubling of the β-hCG levels increased the risk of treatment failure by 54 % (OR 1.54, 95 % CI 1.03–2.39, p < 0.05). Conclusions: Conservative treatment is a safe option for treatment of non-tubal ectopic pregnancy. The presence of embryo heartbeat and β-hCG levels at diagnosis may be used as predictive factors of failure of conservative treatment.</p>}},
author = {{Nedopekina, Ekaterina and Escura, Silvia and Cobo, Teresa and Hansson, Stefan Rocco and Martinez, Josep Maria and Figueras, Francesc and López, Marta}},
issn = {{0301-2115}},
keywords = {{Conservative treatment; Failure of treatment; Intrasaccular injection; Non-tubal ectopic pregnancy}},
language = {{eng}},
pages = {{6--10}},
publisher = {{Elsevier}},
series = {{European Journal of Obstetrics and Gynecology and Reproductive Biology}},
title = {{Conservative treatment in non-tubal ectopic pregnancy and predictors of treatment failure}},
url = {{http://dx.doi.org/10.1016/j.ejogrb.2020.11.067}},
doi = {{10.1016/j.ejogrb.2020.11.067}},
volume = {{257}},
year = {{2021}},
}