ABSTRACT
OBJECTIVE: Our purpose was to investigate whether serum creatine kinase (CK) levels could be used as an early marker of ectopic pregnancy. Student's t-test was used for statistical analysis. STUDY DESIGN: In a prospective study we therefore measured serum progesterone, beta hCG and CK levels in 30 women with ectopic pregnancies, 30 women with ongoing pregnancies and 30 women with missed abortion. RESULTS: The mean serum CK concentration for patients with an ectopic pregnancy, ongoing pregnancy, and the women with missed abortion was 81.4 +/- 66.2, 81.5 +/- 40.3, 84.8 +/- 49.3, respectively. No relationship was found between CK level and the location of the pregnancy. CONCLUSION: Conversely to the first report of Lavie et al. (Am J Obstet Gynecol 1993; 169: 1149), our data suggest that serum CK level is not discriminative in the early diagnosis of tubal pregnancy.
Subject(s)
Biomarkers/blood , Creatine Kinase/blood , Pregnancy, Ectopic/diagnosis , Abortion, Missed/enzymology , Chorionic Gonadotropin, beta Subunit, Human/blood , Female , Humans , Pregnancy , Pregnancy, Ectopic/enzymology , Progesterone/blood , Prospective Studies , Reference ValuesABSTRACT
OBJECTIVE: to compare methotrexate (MTX) to laparoscopic salpingotomy for conservative management of ectopic pregnancy (EP). DESIGN: prospective randomized study. PATIENTS: eighty-nine patients were randomized into 2 groups using a random number table. Inclusion criteria were an EP visualized by ultrasound with a pretherapeutic score < or = 13 as assessed by 6 criteria graded from 1 to 3: gestational age, hCG level, P level, abdominal pain, volume of the hemoperitoneum, and diameter of the hematosalpinx. INTERVENTIONS: 1 mg/kg of MTX injected transvaginally into the ectopic pregnancy without anaesthesia or IM administration (1.5 mg/kg) when EP cannot be safely or easily punctured (group 1) versus laparoscopic salpingotomy (group 2). RESULTS: the success rates defined by hCG levels returned to normal (< 10 mlU/mL) were 43 out of 46 in group 1 and 40 out of 43 in group 2. Medical treatment was significantly associated with shorter post-operative stay (24 vs 46 hours). hCG return to normal was quicker after laparoscopic treatment (13 vs 29 days). Reproductive performances were similar in both groups. CONCLUSIONS: in selected cases of EP with a pretherapeutic score < or = 13, MTX treatment appeared to be as safe and efficient as was conservative treatment by laparoscopy, an expectant management should be offered as a treatment option only in women fulfilling the criteria for a good prognostic.
Subject(s)
Folic Acid Antagonists/therapeutic use , Laparoscopy/methods , Methotrexate/therapeutic use , Pregnancy, Ectopic/therapy , Salpingostomy/methods , Adolescent , Adult , Female , Humans , Length of Stay , Pregnancy , Pregnancy Outcome , Pregnancy, Ectopic/diagnosis , Prospective Studies , Treatment OutcomeABSTRACT
Today, the early diagnosis of ectopic pregnancy (EP) is made possible by the assay of plasmatic hCG and the improvement of trans-vaginal sonography. These different tests lead to diagnose the EP before the ruptured stage. Therefore, the medical treatment is today a logical alternative to the surgical one. The medical treatment is mainly based upon the use of methotrexate (MTX). The logical indications for EP medical treatment are: early EP without peritoneum effusion, with hCG < or = 5000 mUI/ml, without embryonic cardiac activity at sonography. The medical therapy by intramuscular injection of MTX at 1 mg/kg gives a success rate of 91.8% similar to the success rate of intra tubal injection of MTX under sonographic control.
Subject(s)
Folic Acid Antagonists/therapeutic use , Methotrexate/therapeutic use , Patient Selection , Pregnancy, Ectopic/drug therapy , Algorithms , Chorionic Gonadotropin/blood , Decision Trees , Female , Humans , Pregnancy , Pregnancy, Ectopic/diagnosis , Treatment Outcome , Ultrasonography, PrenatalABSTRACT
The ectopic pregnancy (EP) could be treated by spontaneous resolution, or medical treatment or laparoscopic treatment. Spontaneous resolution of EP with beta hCG < 1,000 mUl/ml, plasmatic progesterone < 5 ng/ml had 74% success rate. Methotrexate (MTX) injection is the common Medical treatment of EP with beta hCG < or = 5,000 mUl/ml and mean diameter of EP < or = 3 cm: a single dose of 50 mg/m2 or 1 mg/kg intramuscular injection had 93.4% success rate; local injection under sonographic control (1 mg/kg) had 80.2% success rate. The surgical conservative treatment by laparoscopy had 94% success rate.
