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 |
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container_title | Archives of gynecology and obstetrics |
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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 |
format | Article |
fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_10894165</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2902933482</sourcerecordid><originalsourceid>FETCH-LOGICAL-c426t-f6d336aa1a59d6f2e14e58339dcfae41ced2f735d16b120ef3075a4183a519403</originalsourceid><addsrcrecordid>eNp9kc9PFTEQxxujEUT_AQ6miRcvCzNt99eJGCJqAvECJw_NvO7sumRf-2h3Sfjv6eMhoAdPbTOf-c638xXiEOEIAerjBGDAFKB0AbVqoTCvxD4arfIT8fWL-554l9I1AKqmqd6KPd1A3bQa98WvC_I08Jr9LEMvffDFvKxokuzmsBmd3EQePHk3cpIZne7SmLYkyYniwHLmOI8U76TLEhylo8Qyccz8e_Gmpynxh8fzQFydfb08_V6c__z24_TLeeGMquairzqtKyKksu2qXjEaLhut2871xAYdd6qvddlhtUIF3GuoSzLYaCqxNaAPxMlOd7Os1txtjUSa7CaO62zMBhrt3xU__rZDuLUITWuwKrPC50eFGG4WTrNdj8nxNJHnsCSbl6tarU2jMvrpH_Q6LDEvZktpxBZ1XWVK7SgXQ0qR-yc3CHYbnt2FZ3N49iE8a3LTx5f_eGr5k1YG9A5IueQHjs-z_yN7D_4bpaA</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2931191376</pqid></control><display><type>article</type><title>Management of non-tubal ectopic pregnancies analysis of a large tertiary center case series</title><source>MEDLINE</source><source>SpringerLink Journals</source><creator>Tremmel, E. ; Starrach, T. ; Buschmann, C. ; Trillsch, F. ; Kolben, T. ; Mahner, S. ; Burges, A. ; Kost, B. ; Ehmann, L. ; Burgmann, D. 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 & 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. The Author(s).</rights><rights>The Author(s) 2023. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c426t-f6d336aa1a59d6f2e14e58339dcfae41ced2f735d16b120ef3075a4183a519403</cites><orcidid>0000-0003-4952-0667</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00404-023-07290-4$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00404-023-07290-4$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>230,314,777,781,882,27905,27906,41469,42538,51300</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38078931$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Tremmel, E.</creatorcontrib><creatorcontrib>Starrach, T.</creatorcontrib><creatorcontrib>Buschmann, C.</creatorcontrib><creatorcontrib>Trillsch, F.</creatorcontrib><creatorcontrib>Kolben, T.</creatorcontrib><creatorcontrib>Mahner, S.</creatorcontrib><creatorcontrib>Burges, A.</creatorcontrib><creatorcontrib>Kost, B.</creatorcontrib><creatorcontrib>Ehmann, L.</creatorcontrib><creatorcontrib>Burgmann, D. 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. The results of this study show, that simultaneous treatment with local and systemic MTX had good outcomes and could avoid surgeries.</description><subject>Abortifacient Agents, Nonsteroidal - therapeutic use</subject><subject>Adult</subject><subject>Cesarean Section - adverse effects</subject><subject>Cicatrix - etiology</subject><subject>Endocrinology</subject><subject>Female</subject><subject>Gynecology</subject><subject>Human Genetics</subject><subject>Humans</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Methotrexate - therapeutic use</subject><subject>Obstetrics/Perinatology/Midwifery</subject><subject>Pregnancy</subject><subject>Pregnancy complications</subject><subject>Pregnancy, Cornual - diagnosis</subject><subject>Pregnancy, Cornual - surgery</subject><subject>Pregnancy, Ectopic - diagnosis</subject><subject>Pregnancy, Ectopic - surgery</subject><subject>Retrospective Studies</subject><subject>Review</subject><subject>Treatment Outcome</subject><issn>1432-0711</issn><issn>0932-0067</issn><issn>1432-0711</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kc9PFTEQxxujEUT_AQ6miRcvCzNt99eJGCJqAvECJw_NvO7sumRf-2h3Sfjv6eMhoAdPbTOf-c638xXiEOEIAerjBGDAFKB0AbVqoTCvxD4arfIT8fWL-554l9I1AKqmqd6KPd1A3bQa98WvC_I08Jr9LEMvffDFvKxokuzmsBmd3EQePHk3cpIZne7SmLYkyYniwHLmOI8U76TLEhylo8Qyccz8e_Gmpynxh8fzQFydfb08_V6c__z24_TLeeGMquairzqtKyKksu2qXjEaLhut2871xAYdd6qvddlhtUIF3GuoSzLYaCqxNaAPxMlOd7Os1txtjUSa7CaO62zMBhrt3xU__rZDuLUITWuwKrPC50eFGG4WTrNdj8nxNJHnsCSbl6tarU2jMvrpH_Q6LDEvZktpxBZ1XWVK7SgXQ0qR-yc3CHYbnt2FZ3N49iE8a3LTx5f_eGr5k1YG9A5IueQHjs-z_yN7D_4bpaA</recordid><startdate>20240401</startdate><enddate>20240401</enddate><creator>Tremmel, E.</creator><creator>Starrach, T.</creator><creator>Buschmann, C.</creator><creator>Trillsch, F.</creator><creator>Kolben, T.</creator><creator>Mahner, S.</creator><creator>Burges, A.</creator><creator>Kost, B.</creator><creator>Ehmann, L.</creator><creator>Burgmann, D. M.</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>C6C</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-4952-0667</orcidid></search><sort><creationdate>20240401</creationdate><title>Management of non-tubal ectopic pregnancies analysis of a large tertiary center case series</title><author>Tremmel, E. ; Starrach, T. ; Buschmann, C. ; Trillsch, F. ; Kolben, T. ; Mahner, S. ; Burges, A. ; Kost, B. ; Ehmann, L. ; Burgmann, D. M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c426t-f6d336aa1a59d6f2e14e58339dcfae41ced2f735d16b120ef3075a4183a519403</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Abortifacient Agents, Nonsteroidal - therapeutic use</topic><topic>Adult</topic><topic>Cesarean Section - adverse effects</topic><topic>Cicatrix - etiology</topic><topic>Endocrinology</topic><topic>Female</topic><topic>Gynecology</topic><topic>Human Genetics</topic><topic>Humans</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Methotrexate - therapeutic use</topic><topic>Obstetrics/Perinatology/Midwifery</topic><topic>Pregnancy</topic><topic>Pregnancy complications</topic><topic>Pregnancy, Cornual - diagnosis</topic><topic>Pregnancy, Cornual - surgery</topic><topic>Pregnancy, Ectopic - diagnosis</topic><topic>Pregnancy, Ectopic - surgery</topic><topic>Retrospective Studies</topic><topic>Review</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Tremmel, E.</creatorcontrib><creatorcontrib>Starrach, T.</creatorcontrib><creatorcontrib>Buschmann, C.</creatorcontrib><creatorcontrib>Trillsch, F.</creatorcontrib><creatorcontrib>Kolben, T.</creatorcontrib><creatorcontrib>Mahner, S.</creatorcontrib><creatorcontrib>Burges, A.</creatorcontrib><creatorcontrib>Kost, B.</creatorcontrib><creatorcontrib>Ehmann, L.</creatorcontrib><creatorcontrib>Burgmann, D. M.</creatorcontrib><collection>Springer Nature OA Free Journals</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Archives of gynecology and obstetrics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Tremmel, E.</au><au>Starrach, T.</au><au>Buschmann, C.</au><au>Trillsch, F.</au><au>Kolben, T.</au><au>Mahner, S.</au><au>Burges, A.</au><au>Kost, B.</au><au>Ehmann, L.</au><au>Burgmann, D. 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. The results of this study show, that simultaneous treatment with local and systemic MTX had good outcomes and could avoid surgeries.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>38078931</pmid><doi>10.1007/s00404-023-07290-4</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0003-4952-0667</orcidid><oa>free_for_read</oa></addata></record> |
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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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