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ABSTRACT
Introduction. Ectopic pregnancy is a serious gynaecological complication. Methotrexate is used to treat ectopic pregnancies. In Cameroon, surgery is the treatment of choice. We therefore studied the epidemiology, indications, outcome and success rate of medical treatment of ectopic pregnancy in three reference hospitals in Douala. Materials and methods. A five-year cross-sectional study was carried out in three hospitals in Douala from January 2018 to December 2022. All files presenting an unruptured ectopic pregnancy treated with methotrexate were recruited. Variables included sociodemographic, obstetric history, clinical presentation, paraclinical examinations and complications. Bivariate analysis was used to test the association between predictor variables and medical treatment success. Results. 66 participants received methotrexate as treatment for ectopic pregnancy. The average age was 30.05 ± 5.33 years and the gestational age was 49.88 ± 16.73 days. The most common clinical signs were pelvic pain, abnormal vaginal bleeding and amenorrhea (30.3 %). All patients had a pelvic ultrasound and b-hcg dosage. The prevalence of medical treatment was 13%, a success rate of 63.6 %. The age of the mother, the nulliparous woman, a primigravida, having a cumulative sexual partner, a gestational sac of 1 cm, beta-HCG <5000 miu/ml increased the chances of success of medical treatment. 18.2 % of adverse effects. Conclusion. Few ectopic pregnancies are treated medically. The effectiveness of the treatment is acceptable with few adverse effects.
RÉSUMÉ
Introduction. La grossesse extra-utérine est une complication gynécologique grave. Le méthotrexate est utilisé pour traiter les grossesses extra-utérines. Au Cameroun, la chirurgie est le traitement de choix. Nous avons étudié l'épidémiologie, les indications, l’issue et le taux de réussite du traitement médical de la grossesse extra-utérine dans trois hôpitaux de référence à Douala. Matériels et méthodes. Une étude transversale sur cinq ans a été réalisée dans trois hôpitaux de Douala de janvier 2018 à décembre 2022. Tous les dossiers présentant une grossesse extra-utérine non rompus traitées par méthotrexate ont été recrutés. Les variables comprenaient des variables socio-démographiques, les antécédents obstétricaux, la présentation clinique, les examens cliniques para cliniques et complications. Une analyse bivariée a été utilisée pour tester l'association entre les variables prédictives et le succès du traitement médical. Résultats. 66 participants ont reçu du méthotrexate comme traitement pour la grossesse extra-utérine. L’âge moyen était de 30,05 ± 5,33 ans et l’âge gestationnel de 49,88 ± 16,73 jours. Les signes cliniques les plus représentés étaient la douleur pelvienne, saignement vaginaux anormaux et aménorrhée (30,3 %). Toutes les patientes ont fait une échographie pelvienne et dosage de béta-HCG. La prévalence du traitement médicale était de 13%, un taux de réussite de 63,6 %. L'âge de la mère, la nullipare, une primigeste, avoir un partenaire sexuel cumulé, un sac gestationnel de 1 cm, béta-HCG <5000 mUI/ml augmentaient les chances de succès du traitement médical. 18,2 % des effets indésirables. Conclusion. Peu de grossesses extra-utérines sont traitées médicalement. L’efficacité du traitement est acceptable avec peu d’effets indésirables.
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References
- Cunningham FG, Leveno KJ, Spong CY, Hoffmann BL. Williams Obstetrics. 25th edition Tata McGraw Hill, 2018.593p.
- Hendriks E, Rosenberg R, Prine L. Ectopic Pregnancy: Diagnosis and Management. Am Fam Physician. 2020 May 15;101(10):599–606.
- Olamijulo JA, Okusanya BO, Adenekan MA, Ugwu AO, Olorunfemi G, Okojie O. Ectopic pregnancy at the Lagos University Teaching Hospital, Lagos, South-Western Nigeria: Temporal trends, clinical presentation and management outcomes from 2005 to 2014. Niger Postgrad Med J. 2020;27(3):177–83.
- Essome H, Egbe TO, Halle GE, Nana TN, Boten M, Tocki GT, et al. Epidemiology of ectopic pregnancy at Laquintinie Douala hospital (Cameroon): prevalence survey, clinical profile, therapeutic and transfusion issues. Int J Reprod Contracept Obstet Gynecol. 2020 Dec 26;10(1):44.
- Tebeu PM, Halle-Ekane G, Da Itambi M, Enow Mbu R, Mawamba Y, Fomulu JN. Maternal mortality in Cameroon: a university teaching hospital report. Pan Afr Med J. 2015;21:16.
- Tanaka T, Hayashi H, Kutsuzawa T, Fujimoto S, Ichinoe K. Treatment of interstitial ectopic pregnancy with methotrexate: report of a successful case. Fertil Steril. 1982 Jun;37(6):851–2.
- Ndour SB, Gueye M, Diouf AA, Diallo M. Medical management of ectopic pregnancy in a low resource setting: the role of methotrexate. Int J Reprod Contracept Obstet Gynecol. 2021 Mar 1;10(3):879–85.
- Foumane P, Mboudou ET, Dohbit JS, Mbakop Ndingue S, Tebeu PM, Doh AS. Conservative treatment of ectopic pregnancy in a sub-Saharan African setting. Trop Doct. 2011 Apr 1;41(2):79–81.
- Casanov R, Chuang A, Goepfert AR, Hueppchen NA, Weiss PM. Beckmann and Ling's Obstetrics and Gynwcology American college of Obstetricians anf gynecologists. Eighth edidtion. Wolter Kluwer, 2019.
- Obiegbu NP, Obiegbu AC. Ectopic pregnancy in a teaching hospital in south eastern nigeria.pdf. Afrimedic J. 2021 Nov 23;7(1):5–17.
- Almutairy S, Aldakhil LO. Clinical Presentation as a Predictor of the Response to Methotrexate Therapy in Patients with Ectopic Pregnancy. J Pregnancy. 2022 Nov 28;2022:5778321.
- Thonneau P, Hijazi Y, Goyaux N, Calvez T, Keita N. Ectopic pregnancy in Conakry, Guinea. Bull World Health Organ. 2002;
- Panelli DM, Phillips CH, Brady PC. Incidence, diagnosis and management of tubal and nontubal ectopic pregnancies: a review. Fertil Res Pract. 2015 Oct 15;1(1):15.
- Togas T, Courtney AS. Ectopic pregancy: Epidemiology risk factors and Anatomic sites. Fertil steril.2022 Jun 3.5481.
- Dogan A, Gulhan I, Uyar I, Ekin A, Gezer C, Bilgin M, et al. Methotrexate treatment in progressive tubal ectopic pregnancies and hCG-related clinicosurgical implications. Kaohsiung J Med Sci. 2016;32(6):317–22.
- Foumane P, Meka EJNU, Essiben F, Botsomogo ÉL, Sama JD, Tompeen I, et al. Facteurs associés à l’échec du traitement médical de la grossesse extra-utérine: cas de l’Hôpital Gyneco-Obstétrique et Pédiatrique de Yaoundé. Pan Afr Med J. 2022 Mar 11;41:200.
- Garbin O, Helmlinger C, Meyer N, David-Montefiore E, Vayssiere C. [Can medical treatment be the first-line treatment for most ectopic pregnancies? A series of 202 patients]. J Gynecol Obstet Biol Reprod (Paris). 2010 Feb;39(1):30–6.
- Dogan A, Gulhan I, Uyar I, Ekin A, Gezer C, Bilgin M, et al. Methotrexate treatment in progressive tubal ectopic pregnancies and hCG-related clinicosurgical implications. Kaohsiung J Med Sci. 2016 Jun;32(6):317–22.
- Dhar H, Hamdi I, Rathi B. Methotrexate Treatment of Ectopic Pregnancy: Experience at Nizwa Hospital with Literature Review. Oman Med J. 2011 Mar;26(2):94–8.
- Zhang J, Zhang Y, Gan L, Liu X ying, Du S ping. Predictors and clinical features of methotrexate (MTX) therapy for ectopic pregnancy. BMC Pregnancy Childbirth. 2020 Oct 29;20(1):654.
- Abubakar P, Nwobodo E, Omakanye OL, Ahmed Y, Shebu CE, Borodo AT. Ectopic Pregnancy at Usmanu Danfodiyo University Teaching hospital Sokoto: A ten year review. Annals of Nigerian Medicine Jul-Dec 2012; vol 6.
- Horne AW, Tong S, Moakes CA, Middleton LJ, Duncan WC, Mol BW, et al. Combination of gefitinib and methotrexate to treat tubal ectopic pregnancy (GEM3): a multicentre, randomised, double-blind, placebo-controlled trial. The Lancet. 2023 Feb 25;401(10377):655–63.
- Bonin L, Pedreiro C, Moret S, Chene G, Gaucherand P, Lamblin G. Predictive factors for the methotrexate treatment outcome in ectopic pregnancy: A comparative study of 400 cases. Eur J Obstet Gynecol Reprod Biol. 2017 Jan;208:23–30.
- Hsd
- Fouedjio J, Fouelifack Y, Fouogue T, Kana L, Mbu E. Clinical features of extra-uterine pregnancy in Cameroon: a review of 148 cases at the Yaounde Central Hospital. Facts Views Vis ObGyn. 10(3):165–8.
- Khalil A, Saber A, Aljohani K, Khan M. The Efficacy and Success Rate of Methotrexate in the Management of Ectopic Pregnancy. Cureus. 14(7):e26737.
- Cirik DA, Kinay T, Keskin U, Ozden E, Altay M, Gelisen O. Success rates of single-dose methotrexate and additional dose requirements among women with first and previous ectopic pregnancies. Int J Gynecol Obstet. 2016 Apr;133(1):49–52.
- Lipscomb GH, Givens VA, Meyer NL, Bran D. Previous ectopic pregnancy as a predictor of failure of systemic methotrexate therapy. Fertil Steril. 2004 May 1;81(5):1221–4.
- Nazac A, Gervaise A, Bouyer J, De Tayrac R, Capella-Allouc S, Fernandez H. Predictors of success in methotrexate treatment of women with unruptured tubal pregnancies. Ultrasound Obstet Gynecol. 2003;21(2):181–5.
- Tawfiq A, Agameya AF, Claman P. Predictors of treatment failure for ectopic pregnancy treated with single-dose methotrexate. Fertil Steril. 2000 Nov 1;74(5):877–80.
- Pulatoglu C, Dogan O, Basbug A, Kaya AE, Yildiz A, Temizkan O. Predictive factors of methotrexate treatment success in ectopic pregnancy: A single-center tertiary study. North Clin Istanb. 2018 May 23;5(3):227–31.
References
Cunningham FG, Leveno KJ, Spong CY, Hoffmann BL. Williams Obstetrics. 25th edition Tata McGraw Hill, 2018.593p.
Hendriks E, Rosenberg R, Prine L. Ectopic Pregnancy: Diagnosis and Management. Am Fam Physician. 2020 May 15;101(10):599–606.
Olamijulo JA, Okusanya BO, Adenekan MA, Ugwu AO, Olorunfemi G, Okojie O. Ectopic pregnancy at the Lagos University Teaching Hospital, Lagos, South-Western Nigeria: Temporal trends, clinical presentation and management outcomes from 2005 to 2014. Niger Postgrad Med J. 2020;27(3):177–83.
Essome H, Egbe TO, Halle GE, Nana TN, Boten M, Tocki GT, et al. Epidemiology of ectopic pregnancy at Laquintinie Douala hospital (Cameroon): prevalence survey, clinical profile, therapeutic and transfusion issues. Int J Reprod Contracept Obstet Gynecol. 2020 Dec 26;10(1):44.
Tebeu PM, Halle-Ekane G, Da Itambi M, Enow Mbu R, Mawamba Y, Fomulu JN. Maternal mortality in Cameroon: a university teaching hospital report. Pan Afr Med J. 2015;21:16.
Tanaka T, Hayashi H, Kutsuzawa T, Fujimoto S, Ichinoe K. Treatment of interstitial ectopic pregnancy with methotrexate: report of a successful case. Fertil Steril. 1982 Jun;37(6):851–2.
Ndour SB, Gueye M, Diouf AA, Diallo M. Medical management of ectopic pregnancy in a low resource setting: the role of methotrexate. Int J Reprod Contracept Obstet Gynecol. 2021 Mar 1;10(3):879–85.
Foumane P, Mboudou ET, Dohbit JS, Mbakop Ndingue S, Tebeu PM, Doh AS. Conservative treatment of ectopic pregnancy in a sub-Saharan African setting. Trop Doct. 2011 Apr 1;41(2):79–81.
Casanov R, Chuang A, Goepfert AR, Hueppchen NA, Weiss PM. Beckmann and Ling's Obstetrics and Gynwcology American college of Obstetricians anf gynecologists. Eighth edidtion. Wolter Kluwer, 2019.
Obiegbu NP, Obiegbu AC. Ectopic pregnancy in a teaching hospital in south eastern nigeria.pdf. Afrimedic J. 2021 Nov 23;7(1):5–17.
Almutairy S, Aldakhil LO. Clinical Presentation as a Predictor of the Response to Methotrexate Therapy in Patients with Ectopic Pregnancy. J Pregnancy. 2022 Nov 28;2022:5778321.
Thonneau P, Hijazi Y, Goyaux N, Calvez T, Keita N. Ectopic pregnancy in Conakry, Guinea. Bull World Health Organ. 2002;
Panelli DM, Phillips CH, Brady PC. Incidence, diagnosis and management of tubal and nontubal ectopic pregnancies: a review. Fertil Res Pract. 2015 Oct 15;1(1):15.
Togas T, Courtney AS. Ectopic pregancy: Epidemiology risk factors and Anatomic sites. Fertil steril.2022 Jun 3.5481.
Dogan A, Gulhan I, Uyar I, Ekin A, Gezer C, Bilgin M, et al. Methotrexate treatment in progressive tubal ectopic pregnancies and hCG-related clinicosurgical implications. Kaohsiung J Med Sci. 2016;32(6):317–22.
Foumane P, Meka EJNU, Essiben F, Botsomogo ÉL, Sama JD, Tompeen I, et al. Facteurs associés à l’échec du traitement médical de la grossesse extra-utérine: cas de l’Hôpital Gyneco-Obstétrique et Pédiatrique de Yaoundé. Pan Afr Med J. 2022 Mar 11;41:200.
Garbin O, Helmlinger C, Meyer N, David-Montefiore E, Vayssiere C. [Can medical treatment be the first-line treatment for most ectopic pregnancies? A series of 202 patients]. J Gynecol Obstet Biol Reprod (Paris). 2010 Feb;39(1):30–6.
Dogan A, Gulhan I, Uyar I, Ekin A, Gezer C, Bilgin M, et al. Methotrexate treatment in progressive tubal ectopic pregnancies and hCG-related clinicosurgical implications. Kaohsiung J Med Sci. 2016 Jun;32(6):317–22.
Dhar H, Hamdi I, Rathi B. Methotrexate Treatment of Ectopic Pregnancy: Experience at Nizwa Hospital with Literature Review. Oman Med J. 2011 Mar;26(2):94–8.
Zhang J, Zhang Y, Gan L, Liu X ying, Du S ping. Predictors and clinical features of methotrexate (MTX) therapy for ectopic pregnancy. BMC Pregnancy Childbirth. 2020 Oct 29;20(1):654.
Abubakar P, Nwobodo E, Omakanye OL, Ahmed Y, Shebu CE, Borodo AT. Ectopic Pregnancy at Usmanu Danfodiyo University Teaching hospital Sokoto: A ten year review. Annals of Nigerian Medicine Jul-Dec 2012; vol 6.
Horne AW, Tong S, Moakes CA, Middleton LJ, Duncan WC, Mol BW, et al. Combination of gefitinib and methotrexate to treat tubal ectopic pregnancy (GEM3): a multicentre, randomised, double-blind, placebo-controlled trial. The Lancet. 2023 Feb 25;401(10377):655–63.
Bonin L, Pedreiro C, Moret S, Chene G, Gaucherand P, Lamblin G. Predictive factors for the methotrexate treatment outcome in ectopic pregnancy: A comparative study of 400 cases. Eur J Obstet Gynecol Reprod Biol. 2017 Jan;208:23–30.
Hsd
Fouedjio J, Fouelifack Y, Fouogue T, Kana L, Mbu E. Clinical features of extra-uterine pregnancy in Cameroon: a review of 148 cases at the Yaounde Central Hospital. Facts Views Vis ObGyn. 10(3):165–8.
Khalil A, Saber A, Aljohani K, Khan M. The Efficacy and Success Rate of Methotrexate in the Management of Ectopic Pregnancy. Cureus. 14(7):e26737.
Cirik DA, Kinay T, Keskin U, Ozden E, Altay M, Gelisen O. Success rates of single-dose methotrexate and additional dose requirements among women with first and previous ectopic pregnancies. Int J Gynecol Obstet. 2016 Apr;133(1):49–52.
Lipscomb GH, Givens VA, Meyer NL, Bran D. Previous ectopic pregnancy as a predictor of failure of systemic methotrexate therapy. Fertil Steril. 2004 May 1;81(5):1221–4.
Nazac A, Gervaise A, Bouyer J, De Tayrac R, Capella-Allouc S, Fernandez H. Predictors of success in methotrexate treatment of women with unruptured tubal pregnancies. Ultrasound Obstet Gynecol. 2003;21(2):181–5.
Tawfiq A, Agameya AF, Claman P. Predictors of treatment failure for ectopic pregnancy treated with single-dose methotrexate. Fertil Steril. 2000 Nov 1;74(5):877–80.
Pulatoglu C, Dogan O, Basbug A, Kaya AE, Yildiz A, Temizkan O. Predictive factors of methotrexate treatment success in ectopic pregnancy: A single-center tertiary study. North Clin Istanb. 2018 May 23;5(3):227–31.