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RESOLUTION OF LT.TUBAL ECTOPIC PREGNANCY AFTER METHOTREXATE.


Click on the following Image for a closer, enlarged look . . .

BEFORE METHOTREXATE
Lt. Tubal mass with gestational sac is round 
& distended. Urine test for pregnancy is positive.

3RD DAY AFTER MTX
Lt. Ttubal mass with small &  irregular gestational sac. Urine test for pregnancy is negative.

before Methotrexate

3rd day after MTX

ONE WEEK AFTER MTX.
           Lt.Tubal mass with resolution / absorption
of gestational sac.

AT THE END OF 2ND WEEK
         Lt.Tubal mass is small

One week after

After 2nd week

AT THE END OF 4TH WEEK AFTER MTX.
      Lt Tubal mass is completely resolved.
 Lt .ovary shows immature follicles.

at the end of 4th week

27Y   G2L0    H/O 1ST PREG. IS RT.TUBAL ECTOPIC  -  present G2 pregnancy is Lt. Tubal Ectopic pregnancy.

Findings :1st image : Before Methotrexate shows lt. Tubal mass is round  & distended
                          gestational sac. (Urine test for pregnancy is positive)
               2nd image : 3rd day after Methotrexate. Lt.Tubal mass with small & irregular gestational sac .
                           ( Urine test for pregnancy is negative.)
               3rd image :  At the end of 1st. week after Methotrexate. Lt.Tubal mass with
                               resolution / absorption of gestational sac.
               4th image : At the end of 2nd. week . Lt. Tubal mass is small.
               5th image : At the end of 4th. week. Lt Tubal mass is completely resolved. Lt .ovary
                              shows immature follicles.

Conclusion: Regression of lt.Tubal ectopic pregnancy after methotrexate
Discussion:
Main indications of Mathotrexate in Ectopic pregnancy are unruptured tubal pregnancy of less than 6weeks or gestation sac is less than 3.5cms without cardiac activity & with intact Serosa . 
There should be no Hemoperitonium. Pre-requisites for Methotrexte treatment are base line B HCG levels. Transvaginal scan before Methotrexte  treatment to rule out Hemoperitonium.Liver & renal functional , hematological parameters.

Mode of administration is by systemic & local. In systetic may be single( 50mgs/m 2 - Intramuscular )/multiple doses( 1mg/kg/day on alternate days). Local administration may be by Laproscopic or Transvaginal route ( 10mg  into sac.)

Follow up scan on 4th ,6th day there after weekly if response is good without any complaints.

Prognostic factors
factors are shrinkage in size of gestation sac. &  above 15% fall between 4 and 7 days after injection.5-10% may fail medical treatment and rupture can occurs late as 23 days ,usually occur when gestation sac is above 6weeks with fetal cardiac activity.

Complete resolution
with systemic treatment occurred in 14 +92 days. With TVS injection resolution occurred within 2weeks with lesser dose need & lesser side effects
Tubal potency was restored in 80% of patients treated.

Pregnancy rate following Methotrexate treatment is 61-87%. 8-12 % shows recurrent Ectopic.

Reference : Telindes, Vovak, Textbook of Gyn & Obj.

Submitted  : Dr.M.Adinarayana Rao M.D. & Dr. Prabhavathi M. D.(GYN.&OBG.)



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