ABSTRACT
Background: Various treatments have been proposed to treat ectopic pregnancy, but their impact on future pregnancies is still the subject of controversy
Objective: The aim of this study is to compare the medical and surgical treatment methods and their impact on the subsequent fertility results and complications in women with a history of ectopic pregnancy
Materials and Methods: In this analytical, cross-sectional study, 370 women with the history of ectopic pregnancy, [treared with single dose of methotrexate or salpingectomy by laparotomy], that referred to Al-Zahra Hospital, Rasht, Guilan between 2009 to 2013 were enrolled. 147 women responded to the phone call. The age, the number of women that needed to drug for pregnancy, fertility rate and the fertility outcomes were studied
Result: 147 women responded to the call and between them, 114 women tried to get pregnant again after the ectopic pregnancy treatment. They were agreed to the participate in the study. The mean age of the patients was 28.56 +/- 5.63 yr. The fertility rates in the medical and the surgical groups were 56.6% and 47.61%, respectively [p=0.141]. There were no significant differences in the poor consequences of pregnancy among the two groups; ectopic pregnancy [p=0.605], miscarriage [p=0.605], and prematuredelivery [p=0.648]. 15.1% in the medicinal group and two patients 12.5% in the surgical group had received fertility treatment in order to get pregnant [p=0.135]. There was no significant difference in two groups
Conclusion: It seems that surgical treatment depending on the underlying variables of each patient, can be used such as medical treatment, without worrying about its effect on fertility
ABSTRACT
Nowadays, The first step in treatment of ectopic pregnancy [EP] is medical treatment. Medical treatment with methotrexate [MTX] for EP is safe and effective method without the risks associated with the surgical procedure. But there are controversies between studies for which patients will respond better to medical treatment. The aim of the present study was to investigate the predictive factors of success or failure of treatment of EP with single dose MTX. In this retrospective study, records of 370 patients who were treated for tubal EP with single dose of MTX were reviewed during four years. Patients were divided into two groups; the first group or "success group" are the patients who were successfully treated with MTX. The second group or "failure group" consist the patients who did not respond to the MTX therapy. The week of gestation, size and location of EP and beta-hCG level were compared between groups. Of 370 patients, 285 [77.1%] were successfully treated with MTX. 85 patients [22,9%] required surgery after a mean of 5.4 [range 2-15] days. Day-1 beta-human chorionic gonadotropin [p-hCG] and fall in beta-hCG between day 1 and day 4 were the best predictors for single dose MTX treatment success. The cutoff value of initial beta-hCG with the success treatment results was found to be 1375 lU/mL there was no statistical difference between groups about week of gestation, size and location of EP. The results showed that patients who have beta-hCG levels below 1375 and the number of cases with decreasing beta-hCG level on day 4 are the good candidates for medical treatment