Methotraxate : efficacy and analysis of medical management in tubal pregnancy

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Author: 
Dr. Dinesh Pal Yadav, Dr. Indra Bhati and Dr. Ramgopal Yadav
Subject Area: 
Health Sciences
Abstract: 

Background: Ectopic pregnancy is the most life threatening emergency in pregnancy leading to maternal death. Ectopic pregnancy jeoparadizes the wish of attainmaint of motherhood also, But now therapy for ectopic gestation has evolved from a radical procedure to conservative treatment aimed at the preservation of fertility. Objective: To assess the demographic profile, risk factors, clinical presentation & determine the efficacy of methotrexate treatment for ectopic pregnancies at our tertiary care centre which will not only help in reducing maternal mortality and morbidity rates but also go a long way in preservation of future fertility. Method: A prospective, longitudinal and observational study was conducted in the Department of Obstetrics and Gynaecology, Umaid hospital, Dr. SN Medical college, Jodhpur during a period of two year from October 2013 to September 2015. 32 cases of ectopic pregnancy admitted in the hospital were analyzed in terms of demographic profile, risk factors, clinical presentation, management and efficacy of methotraxate. Finally all collected material and data were analyzed statistically to draw various informative conclusions. Results: Most common age and parity affected by ectopic pregnancy were 21-30 years (63.75%) and para 1-3 (72.50%) respectively. No age and parity were immune to ectopic pregnancy. More than one clinical feature was present in most of the patients. Efficacy of methotraxate in our study was 81.25%. Successfullness of Methotraxate treatment in gestational sac size <4cm was 84% and in D1 β-hCG level <5000 mIU/ml was 88.46%. Effectiveness of methotraxate was decreased when gestational sac size and β-hCG level increased. Conclusion: Medical therapy with MTX has an established place in the treatment of early EP in selected patients with hemodynamic stability and lower initial levels of hCG as the most reliable predictors of treatment outcome and advantage of tubal conservation and saves patients from requiring surgery.

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