Retrospective study on 43 patients with diagnosis of ectopic pregnancy

Scaldarella, L.O. and Carbone, Laura and Mazzarella, Adriano and Ricciardi, Domenico and Chiacchio, Gaetano and Valentino, A. and Mancino, Domenico and Ciccarelli, G.T. and Tolino, Achille (2013) Retrospective study on 43 patients with diagnosis of ectopic pregnancy. Giornale italiano di ostetricia e ginecologia, 35 (2). pp. 419-426. ISSN 1971-1433

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Abstract

Aim. This study aims at outlining the parameters of eligibility to lean toward conservative treatment rather than surgery in case of diagnosis of GEU. Materials and methods. We retrospectively analyzed the data of 43 patients hospitalized at our facility between January 1, 2010 and June 30, 2012 with a diagnosis of GEU. We divided our sample into six groups: patients who underwent surgery within the first 24 h (A), and after the first 24 h (B), treated with methotrexate with positive results (C) and without success (D), and treated with watchful waiting with spontaneous resolution (E) or followed by surgery (F). Descriptive statistics methods were used, and also χ² (Chi-square) and analysis of variance. A transvaginal transducer of 7.5 MHz was used for ultrasound examination. The analyzed parameters were values of beta-hCG, adnexal mass, endometrial thickness and presence and extent of Douglas pouch fluid. Results. Considering the percentage of patients in groups C+E, conservative treatment was possible in 11 patients (25.5%), 4 patients of group C and 7 of group E. Watchful waiting has been successful in 87.5%. Instead, medical therapy has been successful in 57.1% of cases. Conclusions. Therefore we propose a thorough laboratory (beta-hCG < 3000mUI/ml) and ultrasonographic (adnexal mass < 3.5 cm) evaluation, always considering the clinical context of the patient in question. Beta-hCG < 600 mIU/ml, associated with stable clinical condition of the patients, can direct to watchful waiting (laboratory and ultrasound monitoring). Beta-hCG < 3000 mIU/ml, adnexal mass < 3.5 cm, patient in stable conditions and absence of heart rate have been proved to be good cut-off to direct the patient towards a conservative choice (treatment with Methotrexate) rather than invasive (surgery). Finally, Beta-hCG > 3000 mIU/ml and presence of adnexal mass > 3.5 cm as well as presence of fetal heart rate and patient in critical clinical conditions require an emergency surgical approach.

Item Type:	Article
Uncontrolled Keywords:	Extrauterine pregnancy, methotrexate, adnexal mass, beta-hCG
Subjects:	600 Tecnologia - Scienze applicate > 610 Medicina e salute (Classificare qui la tecnologia dei servizi medici) > 618 Altri rami della medicina; Ginecologia e ostetricia, Pediatria, Geriatria
Depositing User:	Matteo Viola
Date Deposited:	11 Sep 2013 16:13
Last Modified:	11 Sep 2013 16:13
URI:	http://eprints.bice.rm.cnr.it/id/eprint/6788

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