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EMAK
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Joined: 26 Nov 2006
Posts: 570
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 Posted: Mon Jan 22, 2007 7:04 pm Post subject: Medical treatment of ectopic pregnancy: |
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Medical treatment of ectopic pregnancy:
1- Methotraxate is needed in higher doses than treating GTD.
2- Methotraxate should always be used under US guidance.
3- Mifepristone can be used in treating EP.
4- Cardiac activity in adnexal mass is a contraindication to
medical treatment.
5- Multiple doses of Methotraxate are less cost effective but
associated with higher success rate of treatment.
6- Single dose Methotraxate is not requiring folinic acid.
7- Methotraxate injections should be continued until β-HCG is less
than 20 iu/l
8- Abdominal pain after treatment with Methotraxate can be
normal in the first 3 days after injections and not need
laparotomy.
9- Intramuscular injection of methotrexate can lead to gastritis,
haematosalpinx and multiple ovarian cysts.[/b] |
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EMAK
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| Posted: Mon Jan 22, 2007 7:06 pm Post subject: |
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Last edited by EMAK on Fri May 16, 2008 7:36 am; edited 1 time in total |
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wolverine
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| Posted: Tue Jan 23, 2007 12:09 am Post subject: |
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hi EMAK! Let me have a go
| Quote: | 1- Methotraxate is needed in higher doses than treating GTD.
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I'd say false. I think you need much more M to kill GTD
| Quote: | 2- Methotraxate should always be used under US guidance.
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False again. It can be given under USS straight into the ectopic by Davor Jurkovic but I don't think that everybody can do it. Unless you mean that you have to have a USS diagnosis of an ectopic with certain features (<3 cms, no FH, no Free fluid etc) and not dealing with a PUL in which case it's true
| Quote: | | 3- Mifepristone can be used in treating EP. |
True I think and in combination with methotraxate higher success rates have been reported
| Quote: | 4- Cardiac activity in adnexal mass is a contraindication to
medical treatment. |
True. It is related with higher failure rates
| Quote: | 5- Multiple doses of Methotraxate are less cost effective but
associated with higher success rate of treatment.
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False. Similar effectiveness for single vs multiple doses (90% and 95% respectively)
| Quote: | | 6- Single dose Methotraxate is not requiring folinic acid. |
Yes, True.
| Quote: | 7- Methotraxate injections should be continued until β-HCG is less
than 20 iu/l
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False. Unless you have personal reasons against the patient!
| Quote: | 8- Abdominal pain after treatment with Methotraxate can be
normal in the first 3 days after injections and not need
laparotomy.
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True but she might need admission as it's sometimes difficult to say "It's not rupture"
| Quote: | 9- Intramuscular injection of methotrexate can lead to gastritis,
haematosalpinx and multiple ovarian cysts |
True. Other side effects bloating, photosensitivity, stomatitis, alopecia, haepatotoxicity |
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mridulaben
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Location: Brunei
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| Posted: Tue Jan 23, 2007 9:28 am Post subject: |
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Agree for all answers with wolverine. WELL DONE  |
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EMAK
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| Posted: Tue Jan 23, 2007 2:11 pm Post subject: |
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--
Last edited by EMAK on Fri May 16, 2008 7:38 am; edited 1 time in total |
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wolverine
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| Posted: Tue Jan 23, 2007 8:42 pm Post subject: |
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| From where? |
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EMAK
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Posts: 570
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| Posted: Tue Jan 23, 2007 8:46 pm Post subject: |
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From No. (1)
If you need a reference.go to TOG. |
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rpwalavalkar
Teale Fenning Administrator
Joined: 20 Jul 2006
Posts: 946
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| Posted: Wed Jan 24, 2007 2:44 am Post subject: |
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hi guys,
i agree with wolverine on all the answers at the first instance.
am on nights now, will read up the TOG article again and get back.
r
_________________
Dr Miss. Raj Walavalkar MBBS MRCOG
TealeFenning Administrator
SR O&G Wessex Region |
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Nick Raine-Fenning
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Joined: 27 May 2006
Posts: 1742
Location: Nottingham
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| Posted: Wed Jan 24, 2007 5:17 pm Post subject: Re: Medical treatment of ectopic pregnancy: |
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| EMAK wrote: | | Medical treatment of ectopic pregnancy: |
| Quote: | 1- Methotrexate is needed in higher doses than treating GTD.
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False - lower
| Quote: | | 2- Methotrexate should always be used under US guidance. |
False
| Quote: | Mifepristone can be used in treating EP.
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True although ? licensed
| Quote: | | Cardiac activity in adnexal mass is a contraindication to medical treatment. |
True
| Quote: | | Multiple doses of Methotraxate are less cost effective but associated with higher success rate of treatment. |
Probably true
| Quote: | | Single dose Methotraxate is not requiring folinic acid. |
True
| Quote: | | Methotraxate injections should be continued until β-HCG is less than 20 iu/l |
False - can be given as a one off and the hCG watched until < 25 iu/L
| Quote: | Abdominal pain after treatment with Methotraxate can be normal in the first 3 days after injections and not need laparotomy[b]
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Absolutely - classic teaching !
| Quote: | | [b]Intramuscular injection of methotrexate can lead to gastritis, haematosalpinx and multiple ovarian cysts |
I believe so
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Nick Raine-Fenning
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| Posted: Wed Jan 24, 2007 5:25 pm Post subject: |
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Looks like I agree with wolverine and crowd on all but one ... EMAK?
I presume you guys are right about the effectiveness of single versus repeated doses of MTX but this seems to be an issue over cost - I will wait to hear the debate 
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EMAK
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| Posted: Wed Jan 24, 2007 6:23 pm Post subject: |
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Hello Nick,
I want to give raj. another chance as she deserve that and I will give you the answers and explanations later on.
Regards. |
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EMAK
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Posts: 570
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| Posted: Thu Jan 25, 2007 1:43 pm Post subject: Re: Medical treatment of ectopic pregnancy: |
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| Nick Raine-Fenning wrote: | | EMAK wrote: | | Medical treatment of ectopic pregnancy: |
| Quote: | 1- Methotrexate is needed in higher doses than treating GTD.
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False - lower
True because normal trophoblastic tissue is more resistant to MTX
| Quote: | | 2- Methotrexate should always be used under US guidance. |
False
Agreed because it can be given IM
| Quote: | Mifepristone can be used in treating EP.
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True although ? licensed
Agreed.
| Quote: | | Cardiac activity in adnexal mass is a contraindication to medical treatment. |
True
It is not CI but associated with higher failure rate.
| Quote: | | Multiple doses of Methotraxate are less cost effective but associated with higher success rate of treatment. |
Probably true
Same success rate.
| Quote: | | Single dose Methotraxate is not requiring folinic acid. |
True
| Quote: | | Methotraxate injections should be continued until β-HCG is less than 20 iu/l |
False - can be given as a one off and the hCG watched until < 25 iu/L
Until hCG < 10 iu/L
| Quote: | Abdominal pain after treatment with Methotraxate can be normal in the first 3 days after injections and not need laparotomy[b]
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Absolutely - classic teaching !
[b]Abdominal pain usually occur at day 6-7
| Quote: | | Intramuscular injection of methotrexate can lead to gastritis, haematosalpinx and multiple ovarian cysts |
I believe so |
[b]True[/b] |
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Nick Raine-Fenning
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Location: Nottingham
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| Posted: Thu Jan 25, 2007 2:02 pm Post subject: Re: Medical treatment of ectopic pregnancy: |
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| EMAK wrote: | | 4- Cardiac activity in adnexal mass is a contraindication to medical treatment. |
Interesting - so you are saying it is not contraindicated? Is the answer true or false then?? Relative CI - true, absolute CI - false??
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Nick Raine-Fenning
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| Posted: Thu Jan 25, 2007 2:03 pm Post subject: |
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| EMAK wrote: | | 5- Multiple doses of Methotraxate are less cost effective but associated with higher success rate of treatment. |
So are you are saying this is false if the success rates are the same?
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Nick Raine-Fenning
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| Posted: Thu Jan 25, 2007 2:05 pm Post subject: |
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| EMAK wrote: | | 7- Methotraxate injections should be continued until β-HCG is less than 20 iu/l. |
Again I think you are saying this is false if you imply treatment should be continued until the hCG is less than 10?
I disagree - monitoring yes but not treatment
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Nick Raine-Fenning
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| Posted: Thu Jan 25, 2007 2:06 pm Post subject: |
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| EMAK wrote: | | 8- Abdominal pain after treatment with Methotraxate can be normal in the first 3 days after injections and not need laparotomy. |
Good question EMAK - the answer is false as it is later - teach me to read the question 
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EMAK
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Posts: 570
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| Posted: Thu Jan 25, 2007 2:31 pm Post subject: Re: Medical treatment of ectopic pregnancy: |
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| Nick Raine-Fenning wrote: | | EMAK wrote: | | 4- Cardiac activity in adnexal mass is a contraindication to medical treatment. |
Interesting - so you are saying it is not contraindicated? Is the answer true or false then?? Relative CI - true, absolute CI - false?? |
Tog [ Non surgical management of ectopic] says it is not an absolute CI
RCOG guidline does not mention frankly this but it says, it should be considered as CI because of high failure rate of medical treatment in the presence of cardiac activity.
you can choose.Nick. |
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EMAK
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Posts: 570
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| Posted: Thu Jan 25, 2007 2:33 pm Post subject: |
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| Nick Raine-Fenning wrote: | | EMAK wrote: | | 5- Multiple doses of Methotraxate are less cost effective but associated with higher success rate of treatment. |
So are you are saying this is false if the success rates are the same? |
yes.False. |
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EMAK
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| Posted: Thu Jan 25, 2007 2:35 pm Post subject: |
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| Nick Raine-Fenning wrote: | | EMAK wrote: | | 7- Methotraxate injections should be continued until β-HCG is less than 20 iu/l. |
Again I think you are saying this is false if you imply treatment should be continued until the hCG is less than 10?
I disagree - monitoring yes but not treatment |
Last and 3rd injection of MTX should be given if the hCG level is above 10 iu. |
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wolverine
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| Posted: Thu Jan 25, 2007 7:00 pm Post subject: |
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| Quote: | | 8- Abdominal pain after treatment with Methotraxate can be normal in the first 3 days after injections and not need laparotomy. |
Hang on... So everybody who comes with some abdominal pain on day 1, 2 or 3 after methotrexate has to have a LAPAROTOMY?! |
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