Methotrexate therapy for ectopic pregnancies: A tertiary center experience

Abstract Objective Our aim is to demonstrate the importance of methotrexate (MTX) therapy for the treatment of ectopic pregnancy (EP). Methods This retrospective study consisted of 99 patients (72 tubal EPs, 20 pregnancies of unknown location (PUL), 4 cesarean section (CS) scar EPs and 3 cervical EPs) treated with MTX. Results Methotrexate therapy was successful in 68.5% of EPs. There were statistically significant differences between the MTX success and failure groups based on ultrasonographic findings, patient complaints, gestational week and serum human chorionic gonadotropin (hCG) values. The MTX success rates in PUL and tubal pregnancies were 95% and 61.1%, respectively. The MTX success rates in single-dose, two-dose and multi-dose protocol groups were 86.9%, 28.6% and 40%, respectively. All cervical and CS scar ectopic pregnancies were treated successfully with MTX therapy. Conclusion Methotrexate might be the first-line treatment option for EPs under certain conditions. Physicians must be more cautious in cases with higher hCG values, the presence of abdominal-pelvic pain, the presence of fetal cardiac activity, larger gestational sac (GS) diameters, and more advanced gestational weeks according to the last menstrual period.

Hemorrhoids and related complications in primigravid pregnancy / Hemorroidas e complicações relacionadas na gestação de primigestas

ABSTRACT Purpose: To identify the effect of pregnancy on the development of external hemorrhoids and constipation. Subjects and methods: This pilot study involved 61 primigravid women without a history of perianal diseases. Each patient was examined and filled a questionnaire between the 11th and 14th gestational week prior to prenatal screening tests. Patients were re-examined and questioned in relation to perianal symptoms and hemorrhoidal changes again in the 24th and 37th gestational weeks. Results: A total of 5, 8, and 11 women had symptomatic external hemorrhoids with or without perianal complications in the 11-14th, 24th, and 37th gestational weeks, respectively. Meanwhile, 27, 25, and 29 women complained about constipation in the 11-14th, 24th, and 37th gestational weeks, respectively. Only 4 (6.6%) patients experienced painful hemorrhoids. The overall morbidity rate was 18% (11 cases). We found a statistically significant relationship between external hemorrhoids/perianal complications and gestation-induced constipation through logistic regression analysis (p < 0.001). Conclusion: Various risk factors and biological explanations exist for the high frequency of hemorrhoids during pregnancy. Because participants were primigravid women without a history of perianal complaints, findings suggest a direct effect of pregnancy itself on the development of external hemorrhoids/perianal symptoms.

RESUMO Objetivo: Identificar o efeito da gestação sobre o desenvolvimento de hemorroidas externas e obstipação. Indivíduos e métodos: Este estudo piloto envolveu 61 mulheres primigestas sem história de doenças perianais. Cada paciente foi examinada e preencheu um questionário entre a 11ª e a 14ª semanas de gestação antes dos exames de triagem pré-natal. As pacientes foram reexaminadas e questionadas sobre sintomas perianais e mudanças hemorroidais novamente na 24ª e 37ª semanas de gestação. Resultados: Um total de 5, 8 e 11 mulheres apresentaram hemorroidas externas sintomáticas com ou sem complicações perianais na 11-14ª, 24ª e 37ª semanas de gestação, respectivamente. Enquanto isso, 27, 25 e 29 mulheres queixaram-se de obstipação na 11-14ª, 24ª e 37ª semanas de gestação, respectivamente. Apenas 4 (6,6%) pacientes apresentaram hemorroidas dolorosas. A taxa global de morbidade foi de 18% (11 casos). Encontramos uma relação estatisticamente significativa entre hemorroidas externas/complicações perianais e obstipação induzida por gestação por meio de análise de regressão logística (p < 0,001). Conclusão: Existem vários fatores de risco e explicações biológicas para a alta frequência de hemorroidas durante a gravidez. Como os participantes eram mulheres primigestas sem história de queixas perianais, os achados sugerem um efeito direto da gestação em si sobre o desenvolvimento de hemorroidas externas/sintomas perianais.