Effectiveness of conservative medical treatment for non-tubal ectopic pregnancies: a multicenter study - 21/04/20

Doi : 10.1016/j.jogoh.2020.101762

Sophie Delplanque ^a,^b, Maela Le Lous ^a,^b, Marie Flévin ^a, Estelle Bauville ^a,^c, Pierre Yves Moquet ^d, Ludivine Dion ^a,^b, Arnaud Fauconnier ^d, Sonia Guérin ^a,^b, Jean Leveque ^a,^b, Vincent Lavoué ^a,^b, Krystel Nyangoh Timoh ^a,^b,⁎
^a Department of Obstetrics and Gynecology, CHU Rennes Hospital, 35000 Rennes, France
^b Université de Rennes 1 : 2 avenue de Professeur Léon Bernard, 35000, Rennes, France
^c Department of Gynecology and Obstetrics, CHI Poissy-St-Germain, 78300 Poissy, France
^d Department of Gynecology and Obstetrics, Clinique mutualiste La sagesse, 35 000 Rennes, France

^⁎Corresponding author at: Service de Gynécologie-Obstétrique, Hôpital Sud Rennes, 16 Boulevard de Bulgarie, 35000 Rennes, France.Service de Gynécologie-ObstétriqueHôpital Sud Rennes16 Boulevard de BulgarieRennes35000France

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Abstract

Objective

To assess the effectiveness of conservative treatment for the management of non-tubal ectopic pregnancies (NTEP)

Methods

Retrospective cohort study in three centers (two referral centers) of patients managed for NTEP diagnosed by 2D or 3D ultrasonograhy. Patients underwent one of the following: expectant management, systemic methotrexate (MTX) injection, local MTX injection, combined MTX injection (local and systemic), local injection of hyperosmolar glucose, or misoprostol administration. The primary endpoint was final success defined by resolution of hCG level without need for emergency surgical treatment. Sixty-four patients diagnosed with NTEP were included: 37 (57%) had an interstitial pregnancy, 23 (35.9%) a cesarean scar pregnancy, two (3.1%) a cervical pregnancy and two (3.1%) an ovarian pregnancy.

Results

Six patients (9.4%) underwent expectant management, 24 (37.5%) a systemic MTX injection, 28 (43.8%) a local injection of MTX, three (4.7%) a combined MTX injection, one (1.6%) a local injection of hyperosmolar glucose (1.6%), and two (3.1%) were administered misoprostol. The median age was 32 years (22-45) and mean follow-up was 41 months. The final success rate overall was 92.2%: 100% for expectant management, 87.5% for systemic MTX, 96.4% for local MTX, 100% for combined injection of MTX, 100% for local injection of hyperosmolar glucose, and 50% for misoprostol. No patient required a hysterectomy. Nine (14.1%) patients required surgery, including five (7.8% (5/64)) following a rupture of the NTEP.

Conclusions

Our results suggest that conservative medical management of NTEP is effective and safe and should be the first-line treatment for pauci-symptomatic patients with an NTEP.

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Keywords : Cesarean scar pregnancy, Interstitial pregnancy, Local methotrexate, Non-tubal ectopic pregnancy, Systemic methotrexate