Treatment of ectopic pregnancy by transvaginal intratubal methotrexate administration

Article Abstract:

Tubal ectopic pregnancy occurs when the fertilized egg implants in the fallopian tubes rather than in the uterus. It results not only in a failed pregnancy, but also may lead to damage to the tubes that can prevent further pregnancies. Early detection and treatment of ectopic tubal pregnancies can maintain the integrity of the tubes for future pregnancies. Recent diagnostic advances have made early detection much easier. Administration of the drug methotrexate has been shown to be effective in resolving these pregnancies without damaging the tubes. The major problem with this treatment is that the drug also causes side effects. Some recent studies have shown these side effects may be avoided if the drug is given locally by administering it transvaginally through a tube. This study examined using this treatment in early tubal ectopic pregnancies. The treatment was given to 12 women with unruptured tubal pregnancies that were detected by rising blood levels of human chorionic gonadotropin (beta-hCG). Repeat treatments were given to four of six patients with live embryos present after the first treatment. Three patients eventually underwent surgery. Serum beta-hCG levels decreased after treatment was begun in the other nine patients, indicating loss of pregnancy. Tubes remained stretched in 8 of these 9 women for up to 24.4 days after treatment and then gradually decreased in size. No major side effects occurred. These results indicate that local administration of methotrexate for treating tubal pregnancies are effective and do not cause the side effects of systemic administration of the drug. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Drug therapy, Dosage and administration

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Laparoscopic tubal sterilization under local anesthesia

Article Abstract:

Surgical sterilization, currently the most popular birth control method, can be performed in women under local anesthesia with excellent results. A retrospective study of 2,827 patients is presented; they underwent sterilization by means of silastic rings placed around the fallopian tubes. The procedure was carried out via laparoscope (a tube and viewing system that allows guidance of surgical instruments into the pelvic cavity). The women had no signs of pelvic adhesions (fibrous tissue) and their uteri could be palpated (felt). A description of the surgical procedure is presented. Local anesthesia was administered in the periumbilical area (around the umbilicus). Patients were treated on an outpatient basis and went home soon after the procedure with medicine for pain relief. They returned two weeks later for a follow-up appointment. Four procedures could not be completed because of adhesions or other complications. The average duration of the surgery was 10 minutes, with the effects of anesthesia lasting approximately 23 minutes. The hospital's fee for the procedure was $350, significantly less than if sterilization had been performed under general anesthesia. The overall technical failure rate (inability to complete the procedure as planned) was 0.14 percent. No unplanned laparotomies (surgical opening of the abdomen) had to be performed. These results are more favorable than those reported in other studies, and suggest that, with appropriate techniques, laparoscopic tubal sterilization can be successfully performed under local anesthesia. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Usage, Evaluation, Tubal sterilization, Local anesthesia

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The treatment of unruptured tubal pregnancy with intratubal methotrexate injection under laparoscopic control

Article Abstract:

Tubal pregnancy (implantation of the developing embryo at the blastocyst stage in the fallopian tube) is a dangerous condition that demands early treatment. Modern approaches have made early diagnosis easier; microsurgery, laparoscopy (a fiber optics microscope and tube that allow visualization and treatment of the reproductive organs), and laser treatment are used to diagnose and even treat tubal pregnancy. Another approach employs methotrexate (a toxic agent), which is administered intravenously. To avoid the complications and side effects of this mode of methotrexate therapy, a laparoscope was used to inject methotrexate into the site where the blastocyst had implanted in nine women with unruptured tubal pregnancy. Eight patients required only one injection, and one patient needed two because adhesions were subsequently detected in the area. Urinary levels of hCG (human chorionic gonadotropin), which rise and indicate the progression of pregnancy, fell to normal in seven patients after the local methotrexate injection. Normal levels of hCG were reached within 29 days for the remaining two patients. Regular ovulatory cycles resumed for all patients, and no side effects were noted. Examination of the fallopian tubes between one and three months later demonstrated that all the involved tubes remained open. This method is safe, easy, and effective, and should be considered for patients with unruptured tubal pregnancies. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects

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