comparative study of single dose, double-dose methotrexate and surgical management of ectopic pregnancy regarding safety, efficacy and tubal patency

To evaluate the safety, efficacy of two Meth-otrexate [MTX] regimens for treatment of ectopic pregnancy [EP] and determine the future fertility after medical and surgical management of ectopic pregnancy. 75 cases with EP, 52 were stable and eligible for medical treatment. 24 cases received MTX 50mg/m2, additional dose was given one week later if B-HCG did not decline by 15% between day 4 and 7, while 28 cases received MTX 50mg/m[2] on days 0 and 4, additional doses were given on day 7 and/or on day 11 if HCG levels did not decrease by 15% during the follow-up period. 23 cases underwent surgery. Hysterosalpingogram [HSG] was performed to assess future fertility of patients after receiving treatment for EP. Overall success rate for single-dose and double-dose protocol was 79% and 85.7% respectively. The difference in success rate between the two regimens was most evident at B-HCG concentrations between 2000-5000mIU/mL; 75% for the single dose regimen and 85.7% for the two-dose regimen which favor using the two-dose regimen in this category of patients. Treatment was well tolerated in both groups, most side effects were mild and transient. Regarding future fertility; tubal patency was 94.2% after medical treatment and 82.6% after salpingectomy. The 2-dose protocol is a hybrid between the two previously established protocols; the single dose and the multi-dose MTX. It may optimize the balance between convenience and efficacy. Single-dose regimen is most suitable for low B-HCG <2000mIU/mL mIU/mL, the 2-dose regimen is more suitable for higher B-HCG 2000-5000, while B-HCG >5000mIU/mL has a high failure rate with medical treatment. In a limted number of patients, no safety concerns were noted with either the single-dose or the 2-dose protocols. Medical treatment should be offered to stable patients whenever feasible because it preserves their future fertility meanwhile cost effective

comparison of supracervical foley catheter, prostaglandin E2 tablet and combination of foley catheter and prostaglandin E2 tablet for cervical ripening and labor induction

The purpose of this study is to compare the efficacy and safety of supra-cervical Foley Catheter and vaginal prostaglandin E[2] [PGE[2]] tablet and combination of supracervical Foley Catheter and PGE[2] tablet for cervical ripening and labor induction. 90 patients admitted for induction of labor with a Bishop score