Management of non-tubal ectopic pregnancies analysis of a large tertiary center case series

Purpose Ectopic pregnancies include cesarean scar (CSP), cornual and cervical pregnancies. Various treatment modalities have been- described, but no standardized procedure has been defined so far. The aim of our analysis was to evaluate the diagnostics and treatment at the Department of Obstetrics a...

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Veröffentlicht in:Archives of gynecology and obstetrics 2024-04, Vol.309 (4), p.1227-1236
Hauptverfasser: Tremmel, E., Starrach, T., Buschmann, C., Trillsch, F., Kolben, T., Mahner, S., Burges, A., Kost, B., Ehmann, L., Burgmann, D. M.
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container_end_page 1236
container_issue 4
container_start_page 1227
container_title Archives of gynecology and obstetrics
container_volume 309
creator Tremmel, E.
Starrach, T.
Buschmann, C.
Trillsch, F.
Kolben, T.
Mahner, S.
Burges, A.
Kost, B.
Ehmann, L.
Burgmann, D. M.
description Purpose Ectopic pregnancies include cesarean scar (CSP), cornual and cervical pregnancies. Various treatment modalities have been- described, but no standardized procedure has been defined so far. The aim of our analysis was to evaluate the diagnostics and treatment at the Department of Obstetrics and Gynecology, LMU University Hospital, Munich. Methods In this retrospective, single-center analysis, 24 patients treated between 2015 and 2020 were analyzed. After verification of the diagnosis by imaging and HCG–analysis, the treatment was individually determined: therapy with methotrexate (MTX) locally with or without simultaneous systemic treatment, surgical treatment via curettage, excision with uterine reconstruction even hemi hysterectomy. Results Ten patients presented with CSP, six with cervical and eight with cornual pregnancies. Median age was 34.6 years. CSP was treated with local MTX in six cases; five required additional treatment with systemic MTX or curettage. Primary curettage or surgery was performed in four cases. In cervical pregnancies the primary therapy with local MTX injection and systemic treatment was performed in 50%. One patient was treated with MTX and insertion of a Bakri balloon. Trachelectomy was required in one case. 50% of cornual pregnancies were treated with MTX locally and intramuscularly and 50% received surgery. Conclusion Treatment strategies were based on the patient’s individual risk parameters. The results of this study show, that simultaneous treatment with local and systemic MTX had good outcomes and could avoid surgeries.
doi_str_mv 10.1007/s00404-023-07290-4
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M.</creator><creatorcontrib>Tremmel, E. ; Starrach, T. ; Buschmann, C. ; Trillsch, F. ; Kolben, T. ; Mahner, S. ; Burges, A. ; Kost, B. ; Ehmann, L. ; Burgmann, D. M.</creatorcontrib><description>Purpose Ectopic pregnancies include cesarean scar (CSP), cornual and cervical pregnancies. Various treatment modalities have been- described, but no standardized procedure has been defined so far. The aim of our analysis was to evaluate the diagnostics and treatment at the Department of Obstetrics and Gynecology, LMU University Hospital, Munich. Methods In this retrospective, single-center analysis, 24 patients treated between 2015 and 2020 were analyzed. After verification of the diagnosis by imaging and HCG–analysis, the treatment was individually determined: therapy with methotrexate (MTX) locally with or without simultaneous systemic treatment, surgical treatment via curettage, excision with uterine reconstruction even hemi hysterectomy. Results Ten patients presented with CSP, six with cervical and eight with cornual pregnancies. Median age was 34.6 years. CSP was treated with local MTX in six cases; five required additional treatment with systemic MTX or curettage. Primary curettage or surgery was performed in four cases. In cervical pregnancies the primary therapy with local MTX injection and systemic treatment was performed in 50%. One patient was treated with MTX and insertion of a Bakri balloon. Trachelectomy was required in one case. 50% of cornual pregnancies were treated with MTX locally and intramuscularly and 50% received surgery. Conclusion Treatment strategies were based on the patient’s individual risk parameters. The results of this study show, that simultaneous treatment with local and systemic MTX had good outcomes and could avoid surgeries.</description><identifier>ISSN: 1432-0711</identifier><identifier>ISSN: 0932-0067</identifier><identifier>EISSN: 1432-0711</identifier><identifier>DOI: 10.1007/s00404-023-07290-4</identifier><identifier>PMID: 38078931</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Abortifacient Agents, Nonsteroidal - therapeutic use ; Adult ; Cesarean Section - adverse effects ; Cicatrix - etiology ; Endocrinology ; Female ; Gynecology ; Human Genetics ; Humans ; Medicine ; Medicine &amp; Public Health ; Methotrexate - therapeutic use ; Obstetrics/Perinatology/Midwifery ; Pregnancy ; Pregnancy complications ; Pregnancy, Cornual - diagnosis ; Pregnancy, Cornual - surgery ; Pregnancy, Ectopic - diagnosis ; Pregnancy, Ectopic - surgery ; Retrospective Studies ; Review ; Treatment Outcome</subject><ispartof>Archives of gynecology and obstetrics, 2024-04, Vol.309 (4), p.1227-1236</ispartof><rights>The Author(s) 2023</rights><rights>2023. 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M.</creatorcontrib><title>Management of non-tubal ectopic pregnancies analysis of a large tertiary center case series</title><title>Archives of gynecology and obstetrics</title><addtitle>Arch Gynecol Obstet</addtitle><addtitle>Arch Gynecol Obstet</addtitle><description>Purpose Ectopic pregnancies include cesarean scar (CSP), cornual and cervical pregnancies. Various treatment modalities have been- described, but no standardized procedure has been defined so far. The aim of our analysis was to evaluate the diagnostics and treatment at the Department of Obstetrics and Gynecology, LMU University Hospital, Munich. Methods In this retrospective, single-center analysis, 24 patients treated between 2015 and 2020 were analyzed. After verification of the diagnosis by imaging and HCG–analysis, the treatment was individually determined: therapy with methotrexate (MTX) locally with or without simultaneous systemic treatment, surgical treatment via curettage, excision with uterine reconstruction even hemi hysterectomy. Results Ten patients presented with CSP, six with cervical and eight with cornual pregnancies. Median age was 34.6 years. CSP was treated with local MTX in six cases; five required additional treatment with systemic MTX or curettage. Primary curettage or surgery was performed in four cases. In cervical pregnancies the primary therapy with local MTX injection and systemic treatment was performed in 50%. One patient was treated with MTX and insertion of a Bakri balloon. Trachelectomy was required in one case. 50% of cornual pregnancies were treated with MTX locally and intramuscularly and 50% received surgery. Conclusion Treatment strategies were based on the patient’s individual risk parameters. 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M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Management of non-tubal ectopic pregnancies analysis of a large tertiary center case series</atitle><jtitle>Archives of gynecology and obstetrics</jtitle><stitle>Arch Gynecol Obstet</stitle><addtitle>Arch Gynecol Obstet</addtitle><date>2024-04-01</date><risdate>2024</risdate><volume>309</volume><issue>4</issue><spage>1227</spage><epage>1236</epage><pages>1227-1236</pages><issn>1432-0711</issn><issn>0932-0067</issn><eissn>1432-0711</eissn><abstract>Purpose Ectopic pregnancies include cesarean scar (CSP), cornual and cervical pregnancies. Various treatment modalities have been- described, but no standardized procedure has been defined so far. The aim of our analysis was to evaluate the diagnostics and treatment at the Department of Obstetrics and Gynecology, LMU University Hospital, Munich. Methods In this retrospective, single-center analysis, 24 patients treated between 2015 and 2020 were analyzed. After verification of the diagnosis by imaging and HCG–analysis, the treatment was individually determined: therapy with methotrexate (MTX) locally with or without simultaneous systemic treatment, surgical treatment via curettage, excision with uterine reconstruction even hemi hysterectomy. Results Ten patients presented with CSP, six with cervical and eight with cornual pregnancies. Median age was 34.6 years. CSP was treated with local MTX in six cases; five required additional treatment with systemic MTX or curettage. Primary curettage or surgery was performed in four cases. In cervical pregnancies the primary therapy with local MTX injection and systemic treatment was performed in 50%. One patient was treated with MTX and insertion of a Bakri balloon. Trachelectomy was required in one case. 50% of cornual pregnancies were treated with MTX locally and intramuscularly and 50% received surgery. Conclusion Treatment strategies were based on the patient’s individual risk parameters. 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subjects Abortifacient Agents, Nonsteroidal - therapeutic use
Adult
Cesarean Section - adverse effects
Cicatrix - etiology
Endocrinology
Female
Gynecology
Human Genetics
Humans
Medicine
Medicine & Public Health
Methotrexate - therapeutic use
Obstetrics/Perinatology/Midwifery
Pregnancy
Pregnancy complications
Pregnancy, Cornual - diagnosis
Pregnancy, Cornual - surgery
Pregnancy, Ectopic - diagnosis
Pregnancy, Ectopic - surgery
Retrospective Studies
Review
Treatment Outcome
title Management of non-tubal ectopic pregnancies analysis of a large tertiary center case series
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