levoleucovorin and Pregnancy--Tubal

We present 3 cases of tubal pregnancy treated with methotrexate. According to the success that we have been obtaining, and the reports of the literature, we propose a local protocol of management of the unruptured tubal pregnancy using a single injection of intratubal methotrexate.

Topics: Adult; Clinical Protocols; Drug Therapy, Combination; Female; Humans; Injections, Intralesional; Leucovorin; Methotrexate; Pregnancy; Pregnancy, Tubal; Time Factors

This report describes a woman with a cornual pregnancy, documented by laparoscopy and ultrasonography, who was successfully treated with a 1-day high-dose methotrexate regimen and folinic acid rescue. The serum beta-hCG level was 2,260 and increased to 3,060 IU/l on the 5th day after treatment before it fell precipitously to below 250 IU/l 15 days after methotrexate treatment. No side effects were experienced by the patient.

Topics: Adult; Chorionic Gonadotropin; Chorionic Gonadotropin, beta Subunit, Human; Female; Humans; Leucovorin; Methotrexate; Peptide Fragments; Pregnancy; Pregnancy, Tubal; Ultrasonography

Corpus luteum activity was monitored in 15 women undergoing nonsurgical management of ectopic pregnancy with local methotrexate injection followed by alternating oral methotrexate and citrovorum factor (group A, n = 8) or local methotrexate injection alone (group B, n = 7). All patients initially demonstrated a viable corpus luteum (plasma progesterone ranged from 1.4 to 19 ng/ml). The treatment was successful in 14, with the exception of one whose tube ruptured 11 days after local administration of methotrexate, despite a continuous decrease in beta human chorionic gonadotropin, 17 beta-estradiol and plasma progesterone levels. There seems to be no correlation between the success of the treatment and the behavior of beta human chorionic gonadotropin, 17 beta-estradiol and plasma progesterone. Three patients from group A and two from group B displayed an initial rise in beta human chorionic gonadotropin following the initiation of the therapy, but the corpus luteum response differed. In group B patients, 17 beta-estradiol and plasma progesterone levels increased in parallel with beta human chorionic gonadotropin. Group A patients displayed a continuous decrease in 17 beta-estradiol and plasma progesterone levels despite the elevation of beta human chorionic gonadotropin, suggesting a possible effect of the systemic methotrexate on corpus luteum activity.

Topics: Adolescent; Adult; Chorionic Gonadotropin; Chorionic Gonadotropin, beta Subunit, Human; Corpus Luteum; Estradiol; Female; Humans; Leucovorin; Methotrexate; Peptide Fragments; Pregnancy; Pregnancy, Ectopic; Pregnancy, Tubal; Progesterone

Five patients with vital, unruptured interstitial pregnancies of less than 3 cm maximum diameter were treated successfully with methotrexate and leucovorin rescue. Four pregnancies showed cardiac activity. Diagnosis was established with transvaginal ultrasonography in all patients. The human chorionic gonadotrophin serum levels were measured to monitor the effectiveness of therapy. This is the first publication on methotrexate treatment for interstitial twin pregnancy and the first on instillation of methotrexate after puncture and aspiration of interstitial pregnancy. In all cases, total and uneventful regression of trophoblast tissue was achieved. No adverse reactions were observed. The advantages and drawbacks of these therapeutic approaches are discussed. Methotrexate appears to be an effective medical non-surgical treatment for unruptured interstitial pregnancy with or without cardiac activity, and preserves reproductive potential.

Topics: Adult; Chorionic Gonadotropin; Female; Humans; Leucovorin; Methotrexate; Pregnancy; Pregnancy, Multiple; Pregnancy, Tubal; Ultrasonography

We report on the atypical course of a 31-year old primigravida, who underwent conservative treatment for a tubal pregnancy. After confirmation of the diagnosis by means of laparoscopy, a linear salpingotomy and removal of the products of gestation were performed through the laparoscope. Routine measurements of the serum HCG levels postoperatively showed, after a short period of decreasing HCG levels, a new rapid increase of HCG values. At relaparoscopy, evidence for an intraperitoneal dissemination of trophoblastic tissue was found and confirmed by histology. After treatment with 20 mg methotrexate q.i.d. per os for 5 days, HCG levels returned to normal within a short time. Apart from a minor degree of an aphthosal stomatitis, the patient did not experience any major side effects from the treatment.

Topics: Adult; Biomarkers, Tumor; Biopsy; Chorionic Gonadotropin; Choristoma; Combined Modality Therapy; Female; Humans; Laparoscopy; Leucovorin; Methotrexate; Neoplasm Seeding; Peritoneal Neoplasms; Peritoneum; Postoperative Complications; Pregnancy; Pregnancy, Tubal; Salpingostomy; Trophoblasts

In an ongoing clinical trial, 100 patients with an unruptured ectopic pregnancy of 3.5 cm or less in greatest dimension were treated with an outpatient protocol of methotrexate and citrovorum factor chemotherapy. Methotrexate and citrovorum were given on alternating days until the hCG titer had decreased by 15% on 2 consecutive days. The patients ranged in age from 16-40 years, gravidity from 1-8, and parity from 0-5. Twenty-three patients had a previous ectopic pregnancy. Of the 100 patients, 96 (96%) received methotrexate/citrovorum as primary therapy and four (4%) were treated for persistent hCG titers after a conservative surgical procedure. The tubal pregnancies of patient nos. 1-50 were confirmed by laparoscopy, whereas patient nos. 51-100 were diagnosed according to a nonlaparoscopic algorithm. Four patients of 100 failed medical therapy and required surgery. Of these, one had an ectopic pregnancy with cardiac activity, one ruptured after intercourse, and the remaining two cases had no specific identifiable risk factors. Of the ectopic pregnancies with cardiac activity, 80% were successfully treated. Five patients (5%) had methotrexate-related side effects, all after the fourth dose, but none required treatment for these side effects. Hysterosalpingograms done on 58 patients subsequently demonstrated tubal patency in 84.5% on the involved side. To date, 37 pregnancies have occurred in this group, of which 31 (89.2%) were intrauterine and four (10.8%) were recurrent ectopic pregnancies. We conclude that methotrexate/citrovorum is safe, effective, and helps to preserve reproductive performance when used as primary therapy for unruptured ectopic pregnancy and for treatment of persistent disease following a conservative surgical procedure.

Topics: Adolescent; Adult; Algorithms; Chorionic Gonadotropin; Drug Administration Schedule; Drug Therapy, Combination; Female; Humans; Leucovorin; Methotrexate; Pregnancy; Pregnancy, Tubal

With the advent of conservative management of ectopic gestation, several patients have had persistent trophoblastic tissue after their surgical procedure. In the past such patients required repeat laparoscopy or laparotomy and further conservative or radical surgery. However, the use of methotrexate with leukovorum rescue offers a new alternative in the management of patients with persistent trophoblastic tissue after conservative surgery. Two patients with persistent trophoblastic tissue were treated successfully with methotrexate and leukovorum rescue. The use of medical therapy in such patients avoids a second surgical procedure, is associated with few side effects and appears to be an acceptable management alternative.

Topics: Adult; Female; Humans; Leucovorin; Methotrexate; Postoperative Complications; Pregnancy; Pregnancy, Tubal; Trophoblasts

The purpose of this study was to examine return of reproductive potential, hysterosalpingographic findings, and time to conception in patients treated with methotrexate and citrovorum factor for unruptured ectopic pregnancy. Fifty-seven patients with unruptured ectopic pregnancies less than 3.0 cm in greatest dimension were treated with methotrexate and citrovorum factor. The mean time from resolution of the ectopic pregnancy to return of menses was 26.0 (0 to 157) days. Forty-four patients were available for follow-up (2 to 15 months). Nineteen of 23 patients who had hysterosalpingograms demonstrated patency in the ipsilateral tube. Fourteen patients desired pregnancy; 11 of 14 (78.6%) were successful, with 10 of 11 (90.9%) having an intrauterine pregnancy, whereas one of 14 (9.1%) were extrauterine gestations. The mean time from first attempt to achieving pregnancy was 2.3 (1 to 4) months. We conclude that methotrexate and citrovorum factor treatment of unruptured ectopic pregnancy is associated with subsequent tubal patency and does not impair return of menses. Most importantly, the pregnancy rates after this form of therapy appear to be better than those achieved by traditional surgical methods, and are comparable to results after laparoscopic salpingostomy.

Topics: Adolescent; Adult; Female; Follow-Up Studies; Humans; Leucovorin; Methotrexate; Pregnancy; Pregnancy, Ectopic; Pregnancy, Tubal; Reproduction

Ten women with tubal ectopic pregnancy were treated by the injection of methotrexate into the gestational sac under direct laparoscopic vision followed by a course of intramuscular therapy including folinic acid rescue. One course of treatment induced resolution of the extrauterine pregnancy in eight women. Complete resolution (beta-hCG less than 10 miu/ml) was achieved within 6-47 days (mean 14.5 days). Serum beta-hCG levels started to decline 3.4 days from the beginning of therapy. Length of hospital stay was 5-11 days (mean 6.4 days). Treatment failed in two patients. One woman had a laparoscopic tubal clip sterilization concomitantly with methotrexate treatment. Tubal patency was demonstrated in all the other seven women (100%) tested subsequently. There is a need to establish criteria for patient selection before methotrexate becomes a routine treatment for tubal pregnancy.. 10 women with tubal ectopic pregnancy were treated with injections of methotrexate into the gestational sac under direct laparoscopic vision followed by a course of intramuscular therapy including folinic acid rescue. 1 course of treatment induced resolution of the extrauterine pregnancy in 8 women. Complete resolution (beta-HCG 10 miu/m1) was achieved within 6-47 days (mean 14.5 days). Serum beta-HCG levels started to decline 3-4 days from the beginning of therapy. The length of hospital stay was 5-11 days (mean 6.4 days). Treatment failed in 2 patients. 1 woman had a laparoscopic tubal clip sterilization concomitantly with the methotrexate treatment. Tubal patency was demonstrated in the other 7 women (100%) tested subsequently. There is a need to establish criteria for patient selection before methotrexate becomes a routine treatment for tubal pregnancy.

Topics: Adult; Chorionic Gonadotropin; Chorionic Gonadotropin, beta Subunit, Human; Female; Humans; Laparoscopy; Leucovorin; Methotrexate; Peptide Fragments; Pregnancy; Pregnancy, Tubal; Time Factors

Topics: Adult; Female; Humans; Laparoscopy; Leucovorin; Methotrexate; Pregnancy; Pregnancy, Tubal