Success and spontaneous pregnancy rates following systemic methotrexate versus laparoscopic surgery for tubal pregnancies: A randomized trial
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Success and spontaneous pregnancy rates following systemic methotrexate versus laparoscopic surgery for tubal pregnancies: A randomized trial. / Krag Moeller, Lars Bo; Moeller, Charlotte; Thomsen, Sten Grove; Andersen, Lars Franch; Lundvall, Lene; Lidegaard, Øejvind; Kjer, Jens Joergen; Ingemanssen, Jens Lindgren; Zobbe, Vibeke; Floridon, Charlotte; Petersen, Janne; Ottesen, Bent; Moeller, Lars Bo Krag; Møller, Christian Holdflod; Thomsen, Sten Grove; Andersen, Lars Franch; Lundvall, Lene; Lidegaard, Ojvind; Kjer, Jens Joergen; Ingemanssen, Jens Lindgren; Zobbe, Vibeke Bahn; Floridon, Charlotte; Petersen, Janne; Ottesen, Bent.
I: Acta Obstetricia et Gynecologica Scandinavica, Bind 88, Nr. 12, 2009, s. 1331-7.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Success and spontaneous pregnancy rates following systemic methotrexate versus laparoscopic surgery for tubal pregnancies: A randomized trial
AU - Krag Moeller, Lars Bo
AU - Moeller, Charlotte
AU - Thomsen, Sten Grove
AU - Andersen, Lars Franch
AU - Lundvall, Lene
AU - Lidegaard, Øejvind
AU - Kjer, Jens Joergen
AU - Ingemanssen, Jens Lindgren
AU - Zobbe, Vibeke
AU - Floridon, Charlotte
AU - Petersen, Janne
AU - Ottesen, Bent
AU - Moeller, Lars Bo Krag
AU - Møller, Christian Holdflod
AU - Thomsen, Sten Grove
AU - Andersen, Lars Franch
AU - Lundvall, Lene
AU - Lidegaard, Ojvind
AU - Kjer, Jens Joergen
AU - Ingemanssen, Jens Lindgren
AU - Zobbe, Vibeke Bahn
AU - Floridon, Charlotte
AU - Petersen, Janne
AU - Ottesen, Bent
N1 - Keywords: Adult; Chorionic Gonadotropin; Female; Humans; Laparoscopy; Methotrexate; Middle Aged; Pregnancy; Pregnancy, Tubal; Proportional Hazards Models; Prospective Studies; Questionnaires; Young Adult
PY - 2009
Y1 - 2009
N2 - Objective. To determine which treatment should be offered to women with a non-ruptured tubal pregnancy: a single dose of methotrexate (MTX) or laparoscopic surgery. Design. Prospective, randomized, open multicenter study. Setting. Seven Danish departments of obstetrics and gynecology. Sample. A total of 106 women diagnosed with ectopic pregnancy (EP). Methods. Between March 1997 and September 2000, 1,265 women were diagnosed with EP, 395 (31%) were eligible, 109 (9%) were randomized of whom 106 had an EP. The study was originally powered to a sample size of 422 patients. The women were randomized to either medical (MTX; 53) or surgical (laparoscopic salpingotomy; 53) treatment. Follow-up by questionnaire and through national patient databases for a maximum of 10 years. Main outcome measures. Uneventful decline of plasma-human chorionic gonadotropin to less than 5 IU/L, rates of spontaneous, subsequent intrauterine, and recurrent ectopic pregnancies. Results. The success rates were 74% following MTX treatment and 87% after surgery (n.s.); the subsequent spontaneous intrauterine pregnancy rate was 73% after MTX and 62% after surgery; and the EP rate was 9.6% after MTX and 17.3% following surgery (n.s.). Conclusions. In women with an EP, who are hemodynamically stable and wishing to preserve their fertility, medical treatment with single dose MTX tends to be equal to treatment with laparoscopic surgery regarding success rate, complications, and subsequent fertility. Although the two treatment modalities seemed to be similar in outcome, it is crucial that the diagnosis is based on a high-quality ultrasonographic evaluation, as two patients had intrauterine pregnancies despite fulfilling the diagnostic algorithm for EP.
AB - Objective. To determine which treatment should be offered to women with a non-ruptured tubal pregnancy: a single dose of methotrexate (MTX) or laparoscopic surgery. Design. Prospective, randomized, open multicenter study. Setting. Seven Danish departments of obstetrics and gynecology. Sample. A total of 106 women diagnosed with ectopic pregnancy (EP). Methods. Between March 1997 and September 2000, 1,265 women were diagnosed with EP, 395 (31%) were eligible, 109 (9%) were randomized of whom 106 had an EP. The study was originally powered to a sample size of 422 patients. The women were randomized to either medical (MTX; 53) or surgical (laparoscopic salpingotomy; 53) treatment. Follow-up by questionnaire and through national patient databases for a maximum of 10 years. Main outcome measures. Uneventful decline of plasma-human chorionic gonadotropin to less than 5 IU/L, rates of spontaneous, subsequent intrauterine, and recurrent ectopic pregnancies. Results. The success rates were 74% following MTX treatment and 87% after surgery (n.s.); the subsequent spontaneous intrauterine pregnancy rate was 73% after MTX and 62% after surgery; and the EP rate was 9.6% after MTX and 17.3% following surgery (n.s.). Conclusions. In women with an EP, who are hemodynamically stable and wishing to preserve their fertility, medical treatment with single dose MTX tends to be equal to treatment with laparoscopic surgery regarding success rate, complications, and subsequent fertility. Although the two treatment modalities seemed to be similar in outcome, it is crucial that the diagnosis is based on a high-quality ultrasonographic evaluation, as two patients had intrauterine pregnancies despite fulfilling the diagnostic algorithm for EP.
U2 - 10.3109/00016340903188912
DO - 10.3109/00016340903188912
M3 - Journal article
C2 - 19961341
VL - 88
SP - 1331
EP - 1337
JO - Acta Obstetricia et Gynecologica Scandinavica
JF - Acta Obstetricia et Gynecologica Scandinavica
SN - 0001-6349
IS - 12
ER -
ID: 21458672