Skip to main content Accessibility help
×
Home
Hostname: page-component-544b6db54f-8tjh8 Total loading time: 0.489 Render date: 2021-10-16T03:52:09.705Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "metricsAbstractViews": false, "figures": true, "newCiteModal": false, "newCitedByModal": true, "newEcommerce": true, "newUsageEvents": true }

Medical therapy of ectopic gestation: contemporary paradigms

Published online by Cambridge University Press:  03 June 2009

D Chamoun
Affiliation:
Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology, University of Maryland School of Medicine, Baltimore, Maryland, USA
KHH Wong
Affiliation:
Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology, University of Maryland School of Medicine, Baltimore, Maryland, USA
HD McClamrock*
Affiliation:
Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology, University of Maryland School of Medicine, Baltimore, Maryland, USA
*
Associate Professor, Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology, University of Maryland School of Medicine, 405 W. Redwood Street, Third Floor, Baltimore, MD-21201, USA.
Get access

Extract

There has been an increase in the incidence of ectopic pregnancy to epidemic proportions in many developed countries in the past two decades. In 1989, ectopic pregnancy accounted for 1.6% of all pregnancies in the United States of America. This trend may be explained by an increase in the incidence of established risk factors as well as a dramatic improvement in diagnostic tools and advances in reproductive technology. Technologic advances such as highly sensitive radioimmunoassays for the β-subunit of human chorionic gonadotropin (βhCG), the development of high-resolution ultrasound and a heightened physician awareness have revolutionized the clinical management of ectopic pregnancy, leading to earlier and more consistent diagnoses and consequently reduced maternal mortality rates. 1,3–13 Unfortunately, ectopic pregnancy is still associated with a significant morbidity and mortality and contributes substantially to health-care costs. For example ectopic pregnancy complications accounted for 13% of all pregnancy-related deaths and were the leading cause of maternal mortality in African- American women in 1989. Financially, an estimated 1.1 billion dollars was spent in the United States of America alone for the management of ectopic pregnancy in 1990.

Type
Articles
Copyright
Copyright © Cambridge University Press 1996

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1 Centers for Disease Control: ectopic pregnancy – United States, 1989–1989. MMWR Morb Mortal Wkly Rep 1992; 41: 591–94.Google Scholar
2Nederlof, KP, Lawson, HW, Saftlas, AF, Atrash, HK, Finch, EL. Ectopic pregnancy surveillance, United States, 1970–1987. MMWR CDC Surveill Summ 1990; 39 (SS-4): 917.Google ScholarPubMed
3Leach, RE, Ory, SJ. Modern management of ectopic pregnancy. J Reprod Med 1989; 34: 324–38.Google ScholarPubMed
4Riss, PA, Radivojevic, K, Bieglmayer, C. Serum progesterone and human chorionic gonadotropin in very early pregnancy: implications for clinical management. Eur J Obstet Gynecol Reprod Biol 1989; 32: 7177.CrossRefGoogle ScholarPubMed
5Kooi, S, Kock, HCLV. A review of the literature on nonsurgical treatment in tubal pregnancies. Obstet Gynecol Surv 1992; 47: 739–49.CrossRefGoogle ScholarPubMed
6Fossum, GT, Davajan, V, Keltzky, OA. Early detection of pregnancy with transvaginal ultrasound. Fertil Steril 1988; 49: 788–91.CrossRefGoogle ScholarPubMed
7Goldstein, SR, Snyder, JR, Watson, C, Danon, M. Very early pregnancy detection with endovaginal ultrasound. Obstet Gynecol 1988; 72: 200204.Google ScholarPubMed
8Bateman, BG, Nunley, WC, Kolp, LA, Kitchin, JD. Vaginal sonography findings and hCG dynamics of early intrauterine and tubal pregnancies. Obstet Gynecol 1990; 75: 421–27.Google ScholarPubMed
9Crespigny, L Ch de. The value of ultrasound in ectopic pregnancy. Clin Obstet Gynecol 1987; 30: 136–47.CrossRefGoogle ScholarPubMed
10Shapiro, BS, Cullen, M, Taylor, KJ, DeChemey, AH. Transvaginal ultrasound for the diagnosis of ectopic pregnancy. Fertil Steril 1988; 50: 425–29.CrossRefGoogle Scholar
11Timor-Tritsch, IE, Yeh, MN, Peisner, DB, Lesser, KB, Slavik, TA. The use of transvaginal ultrasound in the diagnosis of ectopic pregnancy. Am J Obstet Gynecol 1989; 161: 157–61.CrossRefGoogle Scholar
12Russel, JB. The etiology of ectopic pregnancy. Clin Obstet Gynecol 1987; 30: 181–90.CrossRefGoogle Scholar
13Samuelsson, S, Sjovall, A. Laparoscopy in suspected ectopic pregnancy. Acta Obstet Gynecol Scand 1972; 51: 3135.CrossRefGoogle ScholarPubMed
14Washington, AE, Katz, P. Ectopic pregnancy in the United States: economic consequences and payment source trends. Obstet Gynecol 1993; 81: 287–92.Google ScholarPubMed
15Creinin, MD, Washington, AE. Cost of ectopic pregnancy management: surgery versus methotrexate. Fertil Steril 1993; 60: 963–69.CrossRefGoogle ScholarPubMed
16Slaughter, JL, Grimes, DA. Methotrexate therapy: nonsurgical management of ectopic pregnancy. West J Med 1995; 162: 225–28.Google ScholarPubMed
17Carson, SA, Buster, JE. Ectopic Pregnancy. N Engl J Med 1993; 329: 1174–81.Google ScholarPubMed
18Maymon, R, Shulman, A, Mayrnon, BBS, Bar-Levy, F, Lotan, M, Bahary, C. Ectopic pregnancy, the new gynecological epidemic disease: review of the modern work-up and the nonsurgical treatment option. Int J Fertil 1992; 37: 146–64.Google ScholarPubMed
19Balasch, J, Barn, PN. Treatment of ectopic pregnancy: the new gynaecological dilemma. Human Reprod 1994; 9: 547–58.CrossRefGoogle ScholarPubMed
20Cannon, L, Jesionowska, H. Methotrexate treatment of tubal pregnancy. Fertil Steril 1991; 55: 1033–38.CrossRefGoogle ScholarPubMed
21Seifer, DB, Gutmann, JN, Doyle, MB, Jones, EE, Diamond, MP, DeCherney, AH. Persistent ectopic pregnancy following laparoscopic linear salpingostomy. Obstet Gynecol 1990; 76: 1121–25.Google ScholarPubMed
22Chu, E, Drake, JC, Boarman, D, Baram, J, Allegra, CJ. Mechanism of thymidylate synthase inhibition by methotrexate in human neoplastic cell lines and normal human myeloid progenitor cells. J Biol Cell 1990; 265: 8470–78.Google ScholarPubMed
23Sand, PK, Stubblefield, PA, Ory, SJ. Methotrexate inhibition of normal trophoblasts in vitro. Am J Obstet Gynecol 1986; 155: 324–29.CrossRefGoogle ScholarPubMed
24Oilman, AG, Rail, TW, Knies, AS, Taylor, P. The Pharmacological basis of therapeutics, 8th edition, New York: Pergamon Press, 1990.Google Scholar
25Bleyer, WA. The clinical pharmacology of methotrexate: new applications of an old drug. Cancer 1978; 41: 3651.3.0.CO;2-I>CrossRefGoogle ScholarPubMed
26Ory, SJ, Villanueva, AL, Sand, PK, Tamura, RK. Conservative treatment of ectopic pregnancy with methotrexate. Am J Obstet Gynecol 1986; 154: 1299–306.CrossRefGoogle ScholarPubMed
27Sauer, MV, Gorrill, MJ, Rodi, IA et al. Nonsurgical management of unruptured ectopic pregnancy: an extended clinical trial. Fertil Steril 1987; 48: 752–55.CrossRefGoogle ScholarPubMed
28Ichinoe, K, Wake, N, Shinkai, N, Shiina, Y, Miyazaki, Y, Tanaka, T. Nonsurgical therapy to preserve oviduct function in patients with tubal pregnancies. Am J Obstet Gynecol 1987; 156: 484–87.CrossRefGoogle ScholarPubMed
29Floridon, C, Thomson, SG. Methotrexate treatment of ectopic pregnancy. Acta Obstet Gynecol Scand 1994; 73: 746–52.CrossRefGoogle ScholarPubMed
30Stovall, TG, Ling, FW, Buster, JE. Outpatient chemotherapy of unruptured ectopic pregnancy. Fertil Steril 1989; 51: 435–38.CrossRefGoogle ScholarPubMed
31Stovall, TG, Ling, FW, Gray, LA, Carson, SA, Buster, JE. Methotrexate treatment of unruptured ectopic pregnancy: a report of 100 cases. Obstet Gynecol 1991; 77: 749–53.Google ScholarPubMed
32Stovall, TG, Ling, FW, Gray, LA. Single-dose methotrexate for treatment of ectopic pregnancy. Obstet Gynecol 1991; 77: 754–57.Google ScholarPubMed
33Stovall, TG, Ling, FW. Single-dose methotrexate: an expanded clinical trial. Am J Obstet Gynecol 1993; 168: 1759–65.CrossRefGoogle ScholarPubMed
34Pansky, M, Golan, A, Bukovsky, I, Caspi, E. Nonsurgical management of tubal pregnancy. Am J Obstet Gynecol 1991; 164: 888–95.CrossRefGoogle ScholarPubMed
35Ory, SJ. Chemotherapy for ectopic pregnancy. Obstet Gynecol Clin North Am 1991; 18: 123–34.Google ScholarPubMed
36Goldenberg, M, Bider, D, Admon, D, Mashiach, S, Oelsner, G. methotrexate therapy of tubal pregnancy. Hum Reprod 1993; 8: 660–66.CrossRefGoogle ScholarPubMed
37Prevost, RR, Stovall, TG, Ling, FW. Methotrexate for treatment of unruptured ectopic pregnancy. Clin Pharmacol 1992; 11: 529–32.Google ScholarPubMed
38Li, MC, Nerts, R, Spencer, DB. Effect of methotrexate therapy on choriocarcinoma and chorioadenoma. Proc Soc Exp Biol Med 1956; 93: 361–66.CrossRefGoogle Scholar
39Hreschchyshyn, MM, Naples, JD, Randall, CL. Amethopterin in abdominal pregnancy. Am J Obstet Gynecol 1965; 93: 286–87.CrossRefGoogle Scholar
40Tanaka, T, Hayashi, H, Kutsuzawa, T, Fujimoto, S, Ichinoe, K. Treatment of interstitial ectopic pregnancy with methotrexate: report of a successful case. Fertil Steril 1982; 37: 851–52.CrossRefGoogle ScholarPubMed
41Miyazaki, Y. Non-surgical therapy of ectopic pregnancy. Acta Obstet Gynecol Jpn 1983; 58: 132–43.Google ScholarPubMed
42Chotiner, HC. Nonsurgical management of ectopic pregnancy associated with severe hyperstimulation syndrome. Obstet Gynecol 1985; 66: 740–43.Google ScholarPubMed
43Rodi, IA, Sauer, MV, Gorrill, MJ et al. The medical treatment of unruptured ectopic pregnancy with methotrexate and citrovorum rescue: preliminary experience. Fertil Steril 1986; 46: 811–13.CrossRefGoogle ScholarPubMed
44Haans, LCF, van Kessel, PH, Kock, HCLV. Treatment of ectopic pregnancy with methotrexate: case report. Eur J Obstet Gynecol Reprod Biol 1987; 24: 6367.CrossRefGoogle Scholar
45Sauer, MV, Gorrill, MJ, Rodi, IA et al. Nonsurgical management of unruptured isthmic ectopic pregnancy: preliminary experience. Int J Fertil 1988; 33: 116–19.Google ScholarPubMed
46Sauer, MV, Gorrill, MJ, Rodi, IA, Yeko, TR, Buster, JE. Corpus luteum activity in tubal pregnancy. Obstet Gynecol 1988; 71: 667–70.Google ScholarPubMed
47Carson, SA, Stovall, T, Umstot, E, Andersen, R, Ling, F, Buster, JE. Rising human chorionic somatomammotropin predicts ectopic pregnancy rupture following methotrexate chemotherapy. Fertil Steril 1989; 51: 593–97.CrossRefGoogle ScholarPubMed
48Brown, DL, Felker, RE, Stovall, TG, Emerson, DS, Ling, FW. Serial endovaginal sonography of ectopic pregnancies treated with methotrexate. Obstet Gynecol 1991; 77: 406409.Google ScholarPubMed
49Isaacs, J, Meeks, GR, Hampton, HL et al. Treatment of unruptured ectopic pregnancy with methotrexate. J Miss State Med Assoc 1992; 33: 8185.Google ScholarPubMed
50Prapas, J, Prapas, N, Prapa, S, Papanikolaou, A, Papanikolaou, N. Conservative treatment of ectopic pregnancy with intramuscular administration of methotrexate (MTX-CV). Acta Eur Fertil 1992; 23: 2528.Google Scholar
51Stovall, TG, Ling, FW. Ectopic pregnancy: diagnostic and therapeutic algorithms minimizing surgical intervention. J Reprod Med 1993; 38: 807–12.Google ScholarPubMed
52Henry, MA, Gentry, WL. Single injection of methotrexate for treatment of ectopic pregnancies. Am J Obstet Gynecol 1994; 171: 1584–87.CrossRefGoogle ScholarPubMed
53Donderwinkel, PFJ, Van Der Meer, S, Dorr, JPJ. Methotrexate in management of advanced ectopic pregnancy complicated by ovarian hyperstimulation syndrome. Acta Obstet Gynecol Scand 1994; 73: 753–54.CrossRefGoogle ScholarPubMed
54Wolf, GC, Nickisch, SA, George, KE, Teicher, JR, Simms, TD. Completely nonsurgical management of ectopic pregnancies. Gynecol Obstet Invest 1994; 37: 232–35.CrossRefGoogle ScholarPubMed
55Glock, JL, Johnson, JV, Brumsted, JR. Efficacy and safety of single-dose systemic methotrexate in the treatment of ectopic pregnancy. Fertil Steril 1994; 62: 716–21.CrossRefGoogle ScholarPubMed
56Gross, Z, Rodriguez, JJ, Stalnaker, BL. Ectopic pregnancy: nonsurgical, outpatient evaluation and single-dose methotrexate treatment. J Reprod Med 1995; 40: 371–74.Google ScholarPubMed
57Goldstein, DP. Treatment of unruptured ectopic pregnancy with methotrexate with folinic acid rescue (MTX-FA). Presented at the 34th Annual Clinical Meeting of the American College of Obstetricians and Gynecologists. New Orleans May 1986.Google Scholar
58Kojima, E, Abe, Y, Morita, M, Ito, M, Hirakawa, S, Momose, K. The treatment of unruptured tubal pregnancy with intratubal methotrexate injection under laparoscopic control. Obstet Gynecol 1990; 75: 723–25.Google ScholarPubMed
59Menard, A, Crequat, J, Mandelbrot, L, Hauuy, JP, Madelenat, P. Treatment of unruptured tubal pregnancy by local injection of methotrexate under transvaginal sonographic control. Fertil Steril 1990; 54: 4750.CrossRefGoogle ScholarPubMed
60Tulandi, T, Atri, M, Bret, P, Falcone, T, Khalife, S. Transvaginal intratubal methotrexate treatment of ectopic pregnancy. Fertil Steril 1992; 58: 98100.CrossRefGoogle ScholarPubMed
61Stovall, TG, Ling, FW, Buster, JE. Reproductive performance after methotrexate treatment of ectopic pregnancy. Am J Obstet Gynecol 1990; 162: 1620–24.CrossRefGoogle ScholarPubMed
62Fernandez, H, Lelaidier, C, Baton, C, Bourget, P, Frydman, R. Return of reproductive performance after expectant management and local treatment for ectopic pregnancy. Hum Reprod 1991; 6: 1474–77.CrossRefGoogle ScholarPubMed
63Tepper, R, Nahum, R, Rahamin, E et al. Effects of methotrexate on rabbit oviducts and on cell cultures of bovine oviduct epithelium. Gynecol Obstet Invest 1992; 33: 6568.CrossRefGoogle ScholarPubMed
64Badawy, SZA, Taymour, E, Shaykh, ME et al. Conservative surgical treatment of tubal pregnancy: factors affecting future fertility. Int J Fertil 1986; 31: 187–92.Google ScholarPubMed
65Ross, GT. Congenital anomalies among children born of mothers receiving chemotherapy for gestational trophoblastic neoplasms. Cancer 1976; 37 (S): 1043–47.3.0.CO;2-N>CrossRefGoogle ScholarPubMed
66Walden, PAM, Bagshawe, KD. Reproductive performance of woman successfully treated for gestational trophoblastic tumors. Am J Obstet Gynecol 1976; 125: 1108–14.CrossRefGoogle ScholarPubMed
67Shinagawa, S, Nagayama, M. Cervical pregnancy as a possible sequela of induced abortion: report of 19 cases. Am J Obstet Gynecol 1969; 105: 2822–85.CrossRefGoogle ScholarPubMed
68Yankowitz, J, Leake, J, Huggins, G, Gazaway, P, Gates, E. Cervical ectopic pregnancy: review of the literature and report of a case treated by single-dose methotrexate therapy. Obstet Gynecol Surv 1990; 45: 405–14.CrossRefGoogle ScholarPubMed
69Weyerman, PC, Verhoeven, ATM, Alberda, AT. Cervical pregnancy after in vitro fertilization and embryo transfer. Am J Obstet Gynecol 1989; 161: 1145–46.CrossRefGoogle ScholarPubMed
70Parente, JT, Ou, CS, Levy, J, Legatt, E. Cervical pregnancy analysis: a review and report of five cases. Obstet Gynecol 1983; 62: 7982.Google ScholarPubMed
71Baptisti, A Jr. Cervical pregnancy. Obstet Gynecol 1953; 1: 353–58.Google ScholarPubMed
72Rubin, IC. Cervical pregnancy. Surg Gynecol Obstet 1911; 13: 625–33.Google Scholar
73Studdiford, WE. Cervical pregnancy: a partial review of the literature and a report of two probable cases. Am J Obstet Gynecol 1945; 49: 169–85.CrossRefGoogle Scholar
74Nelson, RM. Bilateral internal iliac artery ligation in cervical pregnancy: conservation of reproductive function. Am J Obstet Gynecol 1979; 134: 145–50.CrossRefGoogle ScholarPubMed
75Marcovici, I, Rosenzweig, BA, Brill, AI, Khan, M, Scommegna, A. Cervical pregnancy: case reports and a current literature review. Obstet Gynecol Surv 1994; 49: 4955.CrossRefGoogle Scholar
76Hofmann, HMF, Urdl, W, Hofler, H, Honigl, W, Tamussino, K. Cervical pregnancy: case reports and current concepts in diagnosis and treatment. Arch Gynecol Obstet 1987; 241: 6369.CrossRefGoogle ScholarPubMed
77Bachus, KE, Stone, D, Suh, B, Thickman, D. Conservative management of cervical pregnancy with subsequent fertility. Am J Obstet Gynecol 1990; 162: 450–51.CrossRefGoogle ScholarPubMed
78Farabow, WS, Fulton, JW, Fletcher, V, Velat, CA, White, JT. Cervical pregnancy treated with methotrexate. NC Med J 1983; 44: 9193.Google ScholarPubMed
79Wolcott, HD, Kaunitz, AM, Nuss, RC, Benrubi, GE. Successful pregnancy after previous conservative treatment of an advanced cervical pregnancy. Obstet Gynecol 1988; 71: 1023–25.Google ScholarPubMed
80Oyer, R, Tarakjian, D, Lev-Toaff, A, Friedman, A, Chatwani, A. Treatment of cervical pregnancy with methotrexate. Obstet Gynecol 1988; 71: 469–71.Google ScholarPubMed
81Stovall, TG, Ling, FW, Smith, WC, Felker, R, Rasco, BJ, Buster, JE. Successful nonsurgical treatment of cervical pregnancy with methotrexate. Fertil Steril 1988; 50: 6722–74.CrossRefGoogle ScholarPubMed
82Skannal, D, Burkman, RT. Cervical pregnancy treated with methotrexate: a case report. J Reprod Med 1989; 34: 496–98.Google ScholarPubMed
83Palti, Z, Rosenn, B, Goshen, R, Ben-Chitrit, A, Yagel, S. Successful treatment of a viable cervical pregnancy with methotrexate. Am J Obstet Gynecol 1989; 161: 1147–48.CrossRefGoogle ScholarPubMed
84Kaplan, BR, Brandt, T, Javaheri, G, Scommegna, A. Successful treatment of a live cervical pregnancy with methotrexate and folinic acid. J Reprod Med 1989; 34: 853–56.Google ScholarPubMed
85Kaplan, BR, Brandt, T, Javaheri, G, Scommegna, A. Nonsurgical treatment of a viable cervical pregnancy with intra-amniotic methotrexate. Fertil Steril 1990; 53: 941–43.CrossRefGoogle ScholarPubMed
86Kim, DS, Hwang, YY, Park, MI. Successful treatment of cervical pregnancy by cervical evacuation after use of methotrexate. Asia Oceania J Obstet Gynaecol 1989; 15: 7175.CrossRefGoogle ScholarPubMed
87Sherer, DM, Abramowicz, JS, Thompson, HO, Liberto, L, Angel, C, Woods, JR. Comparison of transabdominal and endovaginal sonographic approaches in the diagnosis of a case of cervical pregnancy successfully treated with methotrexate. J Ultra Med 1991; 10: 409–11.CrossRefGoogle Scholar
88Roussis, P, Ball, RH, Fleischer, AC, Herbert, CM. Cervical pregnancy: a case report. J Reprod Med 1992; 37: 479–81.Google ScholarPubMed
89Timor-Tritsch, IE, Monteagudo, A, Mandeville, EO, Peisner, DB, Anaya, GP, Pirrone, EC. Successful management of viable cervical pregnancy by local injection of methotrexate guided by transvaginal ultrasonography. Am J Obstet Gynecol 1994; 170: 737–39.CrossRefGoogle ScholarPubMed
90Dall, P, Pfisterer, J, du Bois, A, Wilhelm, C, Pfleiderer, A. Therapeutic strategies in cervical pregnancy: case report. Eur J Obstet Gynecol Reprod Biol 1994; 56: 195200.CrossRefGoogle Scholar
91Mantalenakis, S, Tsalikis, T, Grimbizis, G, Aktsalis, A, Mamopoulos, M, Farmakides, G. Successful pregnancy after treatment of cervical pregnancy with methotrexate and currettage: a case report. J Reprod Med 1995; 40: 409–14.Google Scholar
92Dotters, DJ, Katz, VL, Kuller, JA, McCoy, MC. Successful treatment of a cervical pregnancy with a single low dose methotrexate regimen: a case report. Eur J Obstet Gynecol Reprod Biol 1995; 60: 187–89.CrossRefGoogle Scholar
93Kung, FT, Chang, JC, Hsu, TY, Changchien, CC, Soong, YK. Successful management of a 10-week cervical pregnancy with a combination of methotrexate and potassium chloride feticide. Acta Obstet Gynecol Scand 1995; 74: 580–82.CrossRefGoogle ScholarPubMed
94Hsu, JJ, Chiu, TH, Lai, IM, Soong, YK. Methotrexate treatment of cervical pregnancies with different clinical parameters: a report of three cases. J Reprod Med 1995; 40: 246–50.Google ScholarPubMed
95Barham, JM, Paine, M. Reproductive performance after cervical pregnancy: a review. Obstet Gynecol Surv 1989; 44: 650–55.CrossRefGoogle ScholarPubMed
96Rock, JA. Ectopic pregnancy. In: Thompson, ID, Rock, JA eds. TeLinde's operative gynecology, seventh edition. Philadelphia, PA: JB Lippincott Company, 1992: 428–30.Google Scholar
97Tulandi, T, Vilos, G, Gomel, V. Laparoscopic treatment of interstitial pregnancy. Obstet Gynecol 1995; 85: 465–67.CrossRefGoogle ScholarPubMed
98Gleicher, N, Karanda, V, Rabin, D, Pratt, D. Laparoscopic removal of twin cormial pregnancies after in vitro fertilization. Fertil Steril 1994; 61: 1161–62.CrossRefGoogle ScholarPubMed
99Pasic, R, Wolfe, WM. Laparoscopic diagnosis and treatment of interstitial ectopic pregnancy: a case report. Am J Obstet Gynecol 1990; 163: 587–88.CrossRefGoogle ScholarPubMed
100Brandes, MC, Youngs, DD, Goldstein, DP, Parmley, TH. Treatment of cornual pregnancy with methotrexate: case report. Am J Obstet Gynecol 1986; 155: 655–57.CrossRefGoogle ScholarPubMed
101Fernandez, H, De Ziegler, D, Bourget, P, Feltain, P, Frydman, R. The place of methotrexate in the management of interstitial pregnancy. Hum Reprod 1991; 6: 302306.CrossRefGoogle ScholarPubMed
102Timor-Tritsch, IE, Monteagudo, A, Matera, C, Veit, CR. Sonographic evolution of comual pregnancies treated without surgery. Obstet Gynecol 1992; 79: 1044–49.Google ScholarPubMed
103Goldenberg, M, Bider, D, Oelsner, G, Admon, D, Mashiach, S. Treatment of interstitial pregnancy with methotrexate via hysteroscopy. Fertil Steril 1992; 58: 1234–36.CrossRefGoogle ScholarPubMed
104Karsdorp, VHM, Van der Veen, F, Schats, R, Boer-Meisel, ME, Kenemans, P. Successful treatment with methotrexate of five vital interstitial pregnancies. Hum Reprod 1992; 7: 1164–69.CrossRefGoogle ScholarPubMed
105Perez, JA, Sadek, MM, Savale, M, Boyer, P, Zorn, JR. Local medical treatment of interstitial pregnancy after in-vitro fertilization and embryo transfer (IVF-ET): two case reports. Hum Reprod 1993; 8: 631–34.CrossRefGoogle ScholarPubMed
106Voigt, RR, Van der Veen, F, Karsdorp, VHM, Hogerzeil, HV, Ketting, BW. Treatment of interstitial pregnancy with methotrexate: report of an unsuccessful case. Hum Reprod 1994; 9: 1576–79.CrossRefGoogle ScholarPubMed
107Shamma, FN, Schwartz, LB. Primary ovarian pregnancy successfully treated with methotrexate. Am J Obstet Gynecol 1992; 167: 1307–308.CrossRefGoogle ScholarPubMed
108Chelmow, D, Gates, E, Penzias, AS. Laparoscopic diagnosis and methotrexate treatment of an ovarian pregnancy: a case report. Fertil Steril 1994; 62: 879–81.CrossRefGoogle ScholarPubMed
109Couzinet, B, Le Strat, N, Ulmann, A, Baulieu, EE, Schaison, G. Termination of early pregnancy by the progesterone antagonist RU486 (mifepristone). N Engl J Med 1986; 315: 1565–70.CrossRefGoogle Scholar
110Paris, FX, Henry-Suchet, J, Tesquier, L, Loysel, T, Lofferdo, V, Pez, JP. Le traitement medical des grossesses extra-uterines par le RU486. Un moyen d'eviter la chirurgie. Presse Med 1984; 13: 1219.Google Scholar
111Paris, FX, Henry-Suchet, J, Tesquier, L et al. Interet d'un steroide a action antiprogesterone dans le traitement de la grossesse extra-uterine. Resultats preliminaires. Rev Fr Gynecol Obstet 1986; 81: 3335.Google Scholar
112Paris, FX, Henry-Suchet, J, Tesquier, L et al. Effet d'un antiprogesterone (RU486) sur la grossesse extra-uterine. Rev Fr Gynecol Obstet 1986; 81: 607609.Google Scholar
113Kenigsberg, D, Porte, J, Hull, M, Spitz, IM. Medical treatment of residual ectopic pregnancy: RU486 and methotrexate. Fertil Steril 1987; 47: 702703.CrossRefGoogle ScholarPubMed
114Levin, JH, Lacarra, M, d'Ablaing, G, Grimes, DA, Vermesh, M. Mifepristone (RU486) failure in an ovarian heterotopic pregnancy. Am J Obstet Gynecol 1990; 163: 543–44.CrossRefGoogle Scholar
115Cingotti, M, Moxhon, E, Gandour, A. Traitement de la grossesse extra-uterine par le RU486. A propos d'un cas. Rev Fr Gynecol Obstet 1990; 85: 631–33.Google Scholar
116Altaras, M, Cohen, I, Cordoba, M, Ben-Nun, I, Ben-Aderet, N. Treatment of an interstitial pregnancy with actinomycin D. Case report. Br J Obstet Gynaecol 1988; 95: 1321–23.CrossRefGoogle ScholarPubMed
117Brand, E, Gibbs, RS, Davidson, SA. Advanced cervical pregnancy treated with actinomycin-D. Br J Obstet Gynaecol 1993; 100: 491–92.CrossRefGoogle ScholarPubMed
118Neary, BA, Rose, PG. Complete response of a persistent ectopic pregnancy to dactinomydin after methotrexate failure. A case report. J Reprod Med 1995; 40: 160–62.Google ScholarPubMed
119Wong, LC, Choo, YC, Ma, HK. Primary oral etoposide therapy in gestational tropboblastic disease. An update. Cancer 1986; 58: 1417.3.0.CO;2-R>CrossRefGoogle ScholarPubMed
120Segna, RA, Mitchell, DR, Misas, JE. Successful treatment of cervical pregnancy with oral etoposide. Obstet Gynecol 1990; 76: 945–47.Google ScholarPubMed
121Kusaka, M, Tanaka, T, Fujimoto, S. Local etoposide injection for treatment of tubal pregnancy with cardiac activity. Int J Fertil 1994; 39: 1113.Google ScholarPubMed
122Foon, KA. Advances in cancer: monoclonal antibody therapy of hematologic malignancies. N J Med 1987; 84: 269–74.Google ScholarPubMed
123Sears, HF, Atkinson, B, Mattis, J et al. Phase-I clinical trial of monoclonal antibody in treatment of gastrointestinal tumours. Lancet 1983; 1: 762–65.Google Scholar
124Anderson, DJ, Alexander, NJ. A new look at antifertility vaccines. Fertil Steril 1983; 40: 557–71.Google Scholar
125Frydman, R, Fernandez, H, Troalen, F, Ghillani, P, Rainhorn, JD, Bellet, D. Phase I clinical trial of monoclonal anti-human chorionic gonadotropin antibody in women with an ectopic pregnancy. Fertil Steril 1989; 52: 734–38.CrossRefGoogle ScholarPubMed
126Manyak, MJ, Russo, A, Smith, PD, Glatstein, E. Photodynamic therapy. J Clin Oncol 1988; 6: 380–91.CrossRefGoogle ScholarPubMed
127Dougherty, TJ, Marcus, SL. Photodynamic therapy. Eur J Cancer 1992; 28: 1734–42.CrossRefGoogle Scholar
128Yang, JZ, Van Vugt, DA, Melchior, MF, Hahn, PM, Reid, RL. Photodynamic ablation of early pregnancy in the rat with 5-aminolevulinic acid: a potential new therapy for tubal ectopic pregnancy in the human. Fertil Steril 1994; 62: 1060–65.CrossRefGoogle ScholarPubMed
129Yang, JZ, Greer, PA, Van Vugt, DA, Reid, RL. Treatment with 5-aminolevulinic acid and photoactivating light causes destruction of preimplantation mouse embryos. Fertil Steril 1995; 63: 1088–93.CrossRefGoogle ScholarPubMed
130Pansky, M, Bukovsky, I, Golan, A et al. Local methotrexate injection: a nonsurgical treatment of ectopic pregnancy. Am J Obstet Gynecol 1989; 161: 393–96.CrossRefGoogle ScholarPubMed
131Pansky, M, Bukovsky, I, Golan, A et al. Tubal patency after local methotrexate injection for tubal pregnancy. Lancet 1989; 2: 967–68.CrossRefGoogle ScholarPubMed
132Lang, PF, Weiss, PAM, Mayer, HO, Haas, JG, Honigl, W. Conservative treatment of ectopic pregnancy with local injection of hyperosmolar glucose solution or prostaglandin-F2α: a prospective randomised study. Lancet 1990; 336: 7881.CrossRefGoogle ScholarPubMed
133Egarter, C, Husslein, P. First successful intrauterine pregnancy after treatment of tubal pregnancy with prostaglandin F2α. Am J Obstet Gynecol 1989; 161: 904.CrossRefGoogle Scholar
134Yeko, TR, Mayer, JC, Parsons, AK, Maroulis, GB. A prospective series of unruptured ectopic pregnancies treated by tubal injection with hyperosmolar glucose. Obstet Gynecol 1995; 85: 265–68.CrossRefGoogle ScholarPubMed
135Ali, AFM. Local danazol injection for treatment of unruptured tubal pregnancy (preliminary experience). Eur J Obstet Gynecol Reprod Biol 1993; 49: 137–41.Google Scholar
136Feichtinger, W, Kemeter, P. Conservative treatment of ectopic pregnancy by transvaginal aspiration under sonographic control and methotrexate injection. Lancet 1987; 1: 381–82.CrossRefGoogle ScholarPubMed
137Robertson, DE, Smith, W, Craft, I. Reduction of ectopic pregnancy by ultrasound methods. Lancet 1987; 2: 1524.CrossRefGoogle ScholarPubMed
138Leeton, J, Davison, G. Nonsurgical management of unruptured tubal pregnancy with intra-amniotic methotrexate: preliminary report of two cases. Fertil Steril 1988; 50: 167–69.CrossRefGoogle ScholarPubMed
139Feichtinger, W, Kemeter, P. Treatment of unruptured ectopic pregnancy by needling of sac and injection of methotrexate or PG E2 under transvaginal sonography control. Arch Gynecol Obstet 1989; 246: 8589.CrossRefGoogle ScholarPubMed
140Tulandi, T, Bret, PM, Atri, M, Senterman, M. Treatment of ectopic pregnancy by transvaginal intratubal methotrexate administration. Obstet Gynecol 1991; 77: 627–30.Google ScholarPubMed
141Fernandez, H, Baton, C, Lelaidier, C, Frydman, R. Conservative management of ectopic pregnancy: prospective randomized clinical trial of methotrexate versus prostaglandin sulprostone by combined transvaginal and systemic administration. Fertil Steril 1991; 55: 746–50.CrossRefGoogle ScholarPubMed
142Caspi, B, Barash, A, Friedman, A, Appelman, Z, Pansky, M, Borenstein, R. Aspiration of ectopic pregnancy under guidance of vaginal ultrasonography. Eur J Obstet Gynecol Reprod Biol 1992; 46: 5152.CrossRefGoogle ScholarPubMed
143Porreco, RP. Percutaneous ultrasound-directed ablation of ectopic pregnancy with methotrexate. A report of three cases. J Reprod Med 1992; 37: 363–66.Google ScholarPubMed
144Schiff, E, Shalev, E, Bustan, M, Tsabari, A, Mashiach, S, Weiner, E. Pharmacokinetics of methotrexate after local tubal injection for conservative treatment of ectopic pregnancy. Fertil Steril 1992; 57: 688–90.CrossRefGoogle ScholarPubMed
145Atri, M, Bret, PM, Tulandi, T, Senterman, MK. Ectopic pregnancy: evolution after treatment with transvaginal methotrexate. Radiology 1992; 185: 749–53.CrossRefGoogle ScholarPubMed
146Fernandez, H, Benfila, JL, Lelaidier, C, Baton, C, Frydman, R. Methotrexate treatment of ectopic pregnancy: 100 cases treated by primary transvaginal injection under sonographic control. Fertil Steril 1993; 59: 773–77.CrossRefGoogle ScholarPubMed
147Tzafettas, J, Anapliotis, S, Zournatzi, V, Boucklis, A, Oxouzoglou, N, Bondis, J. Transvaginal intra-amniotic injection of methotrexate in early ectopic pregnancy. Advantages over the laparoscopic approach. Early Hum Dev 1994; 39: 101107.CrossRefGoogle ScholarPubMed
148Fernandez, H, Bourget, P, Ville, Y, Lelaidier, C, Frydman, R. Treatment of unruptured tubal pregnancy with methotrexate: pharmacokinetic analysis of local versus intramuscular administration. Fertil Steril 1994; 62: 943–47.CrossRefGoogle ScholarPubMed
149Fernandez, H, Pauthier, S, Doumerc, S et al. Ultrasound-guided injection of methotrexate versus laparoscopic salpingotomy in ectopic pregnancy. Fertil Steril 1995; 63: 2529.CrossRefGoogle ScholarPubMed
150Risquez, F, Mathieson, J, Pariente, D et al. Diagnosis and treatment of ectopic pregnancy by retrograde selective salpingography and intraluminal methotrexate injection: work in progress. Hum Reprod 1990; 5: 759–62.CrossRefGoogle ScholarPubMed
151Ribic-Pucelj, M, Novak-Antolic, Z, Vrhovec, I. Treatment of ectopic pregnancy with prostaglandin E2. Clin Exp Obstet Gynecol 1989; 16: 106109.Google ScholarPubMed
152Gjelland, K, Hordnes, K, Tjugum, J, Augensen, K, Bergsjo, P. Treatment of ectopic pregnancy by local injection of hypertonic glucose: a randomized trial comparing administration guided by transvaginal ultrasound or laparoscopy. Acta Obstet Gynecol Scand 1995; 74: 629–34.CrossRefGoogle ScholarPubMed
153Honigl, W, Lang, P, Urdl, W, Weiss, PAM. Rupture of tubal pregnancy after transvaginal puncture. Lancet 1990; 336: 885–86.CrossRefGoogle ScholarPubMed
154Robertson, DE, Smith, W, Moye, MA et al. Reduction of ectopic pregnancy by injection under ultrasound control. Lancet 1987; 1: 974–75.CrossRefGoogle ScholarPubMed
155Timor-Tritsch, I, Baxi, L, Peisner, DB. Transvaginal salpingocentesis: a new technique for treating ectopic pregnancy. Am J Obstet Gynecol 1989; 160: 459–61.CrossRefGoogle ScholarPubMed
156Aboulghar, MA, Mansour, RT, Serour, GI. Transvaginal injection of potasisum chloride and methotrexate for the treatment of tubal pregnancy with a live fetus. Hum Reprod 1990; 5: 887–88.CrossRefGoogle Scholar
157Oelsner, G, Admon, D, Shalev, Y, Kukia, E, Mashiach, S. A new approach for the treatment of interstitial pregnancy. Fertil Steril 1993; 59: 924–25.CrossRefGoogle ScholarPubMed
158Prates, MC, Benson, CB, Doubilet, PM et al. Cervical ectopic pregnancy: results of conservative treatment. Radiology 1994; 191: 773–75.Google Scholar
159Lund, J. Early ectopic pregnancy. Comments on conservative treatment. J Obstet Gynaecol Br Emp 1955; 62: 7076.Google ScholarPubMed
160Mashiach, S, Carp, HJA, Serr, DM. Nonoperative management of ectopic pregnancy. A preliminary report. J Reprod Med 1982; 27: 127–32.Google ScholarPubMed
161Carp, HJA, Oelsner, G, Serr, DM, Mashiach, S. Fertility after nonsurgical treatment of ectopic pregnancy. J Reprod Med 1986; 31: 119–22.Google ScholarPubMed
162Adoni, A, Milwidsky, A, Hurwitz, A, Palti, Z. Declining β-hCG levels: an indicator for expectant approach in ectopic pregnancy. Int J Fertil 1986; 31: 4042.Google ScholarPubMed
163Garcia, AJ, Aubert, JM, Sama, J, Josimovich, JB. Expectant management of presumed ectopic pregnancies. Fertil Steril 1987; 48: 395400.CrossRefGoogle ScholarPubMed
164Dericks-Tan, JSE, Scholz, C, Taubert, HD. Spontaneous recovery of ectopic pregnancy: a preliminary report. Eur J Obstet Gynecol Reprod Biol 1987; 25: 181–85.CrossRefGoogle ScholarPubMed
165Fernandez, H, Raihorn, JD, Papiernik, E, Bellet, D, Frydman, R. Spontaneous resolution of ectopic pregnancy. Obstet Gynecol 1988; 71: 171–74.Google ScholarPubMed
166Makinen, JI, Kivijarvi, AK, Irjala, KM. Success of non-surgical management of ectopic pregnancy. Lancet 1990; 335: 1099.CrossRefGoogle ScholarPubMed
167Egarter, C, Kiss, H, Husslein, P. Prostaglandin versus expectant management in early tubal pregnancy. Prostaglandins Leukot Essent Fatty Acids 1991; 42: 177–79.CrossRefGoogle ScholarPubMed
168Ylostalo, P, Cacciatore, B, Koskimies, A et al. Conservative treatment of ectopic pregnancy. Ann NY Acad Sci 1991; 626: 516–23.CrossRefGoogle ScholarPubMed
169Letterie, GS, Hibbert, ML, Ramirez, EJ. Expectant management of abnormal concentrations of human chorionic gonadotropin during the first trimester of pregnancy. Gynecol Obstet Invest 1991; 31: 176–78.CrossRefGoogle ScholarPubMed
170Ylostalo, P, Cacciatore, B, Sjoberg, J, Kaariainen, M, Tenhunen, A, Stenman, UH. Expectant management of ectopic pregnancy. Obstet Gynecol 1992; 80: 345–48.Google ScholarPubMed
171Ylostalo, P, Cacciatore, B, Korhonen, J et al. Expectant management of ectopic pregnancy. Eur J Obstet Gynecol Reprod Biol 1993; 49: 8384.CrossRefGoogle ScholarPubMed
172Atri, M, Bret, PM, Tulandi, T. Spontaneous resolution of ectopic pregnancy: initial appearance and evolution at transvaginal US. Radiology 1993; 186: 8386.CrossRefGoogle ScholarPubMed
173Korhonen, J, Stenman, UH, Ylostalo, P. Serum human chorionic gonadotropin dynamics during spontaneous resolution of ectopic pregnancy. Fertil Steril 1994; 61: 632–36.CrossRefGoogle ScholarPubMed
174Lurie, S, Katz, Z, Goldshmit, R, Gotlibe, Z, Insler, V. Expectant management of suspected ectopic pregnancies even with rising β-subunit human chorionic gonadotropin levels. A clinical prospective study. Arch Gynecol Obstet 1994; 255: 125–29.CrossRefGoogle Scholar
175Shalev, E, Peleg, D, Tsabari, A, Romano, S, Bustan, M. Spontaneous resolution of ectopic tubal pregnancy: natural history. Fertil Steril 1995; 63: 1519.CrossRefGoogle ScholarPubMed
176Trio, D, Strobelt, N, Picciolo, C, Lapinski, RH, Ghidini, A. Prognostic factors for successful expectant management of ectopic pregnancy. Fertil Steril 1995; 63: 469–72.CrossRefGoogle ScholarPubMed
177Cacciatore, B, Korhonen, J, Stenman, UH, Ylostalo, P. Transvaginal sonography and serum hCG in monitoring of presumed ectopic pregnancies selected for expectant management. Ultrasound Obstet Gynecol 1995; 5: 297300.CrossRefGoogle ScholarPubMed
178Yaron, Y, Lessing, JB, Peyser, MR. Expectant management of ectopic pregnancy in the presence of ovarian hyperstimulation syndrome. Acta Obstet Gynecol Scand 1995; 74: 8081.CrossRefGoogle ScholarPubMed
1
Cited by