Reproductive performance after methotrexate treatment of ectopic pregnancy

Article Abstract:

Ectopic pregnancies are pregnancies in which the embryo implants in an area outside the uterus. Most ectopic pregnancies occur in the fallopian tubes, which lead from the ovaries to the uterus. These abnormal pregnancies must be terminated because they pose a serious threat to the mother's health. Microsurgical techniques are now performed in an effort to maintain tubal integrity for future fertility. However, it has been estimated that even with microsurgical techniques, only 68 percent of the patients will become pregnant and only 56 percent will have embryos implant inside of the uterus. A new treatment for ectopic pregnancies involves injecting the embryonic sac with the chemotherapeutic drug, methotrexate. The subsequent reproductive functioning of 57 women with unruptured tubal pregnancies who were treated with methotrexate and citrovorum factor is reported. It took an average of 26 days (0 to 157 days) for the women to begin menstruating again. Follow-up information was available for 44 patients. Of the 23 patients who had a hysterosalpingogram, a method of assessing the patency of the fallopian tubes by injecting a contrast material, 19 women had a functioning tube. During the follow-up period, 11 pregnancies were achieved in the 14 women desiring pregnancy (78.6 percent). The pregnancy implanted inside the uterus in 10 women (90.9 percent) and outside the uterus in one (9.1 percent) woman. It took an average of 2.3 months to achieve pregnancy. It is concluded that methotrexate treatment for ectopic pregnancy did not alter the return of menstruation or the functioning of the fallopian tube. Although pregnancy rates were similar to those following conventional surgical methods of treating ectopic pregnancy, the risks and cost of a surgical operation are eliminated with the methotrexate method. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Care and treatment, Methotrexate

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A randomized trial evaluating leuprolide acetate before hysterectomy as treatment for leiomyomas

Article Abstract:

Leiomyomas are benign (noncancerous) tumors that grow in smooth muscle tissue. When leiomyomas occur in the uterus, a hysterectomy (removal of the uterus) is performed to remove these tumors. The uterus can be removed through an incision made in the abdomen (abdominal hysterectomy) or by an incision made in the vagina (vaginal hysterectomy). Abdominal hysterectomies require a longer period of hospitalization, more blood transfusions, and give rise to more complications than vaginal hysterectomies. However, vaginal hysterectomies are difficult to perform if the uterus is large, and when leiomyomas grow in the uterus they increase the size of the uterus. Previous studies have reported that treatment with a drug that mimics the effect of gonadotropin-releasing hormone, such as leuprolide, can reduce the size of the uterus within eight weeks. A study was performed to determine if treatment with leuprolide would reduce the size of the uterus of women with leiomyomas, thereby making vaginal hysterectomy possible. Twenty-five women with leiomyomas were treated with leuprolide for two months, and 25 patients who were not treated were included for comparison. Treatment with leuprolide reduced the size of the uterus by 33 percent, and made it possible for 76 percent of the treated women to have vaginal hysterectomies. Only 16 percent of the women who were not treated were able to have vaginal hysterectomies. Those who received drug treatment spent an average of four days in the hospital, while those who were not treated spent an average of five days in the hospital. It is concluded that two months of treatment with leuprolide may allow patients with leiomyomas to be candidates for vaginal hysterectomy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Surgery, Drug therapy, Uterus, Hysterectomy, Leuprolide, Uterine fibroids

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Preventing ruptured ectopic pregnancy with a single serum progesterone

Article Abstract:

Ectopic pregnancies are those in which the fertilized egg is implanted outside the uterus. The level of progesterone, a hormone used to prepare the uterus for pregnancy, was measured in emergency room patients suspected of being pregnant. Usual methods of detection of ectopic pregnancy require serial blood collection, and results take up to two days. In some cases these pregnancies could rupture before the diagnosis is confirmed. In 67 cases of ectopic pregnancy, the level of progesterone, obtained during a single blood test, was found to be a quick and reliable indicator, and therefore useful for preventing ruptured ectopic pregnancies. It has been suggested that patients at risk for ectopic pregnancies have routine serum progesterone screening.

Abnormalities, Diagnosis, Blood, Progesterone

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