Volume 21, Issue 5 (May 2023)                   IJRM 2023, 21(5): 403-414 | Back to browse issues page

XML Persian Abstract Print

Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
Tarfdari A, Bandarian M, Hantoushzadeh S, Hadizadeh A, Shahsavari S, Razavi M A. Assessing the risk factors and management outcomes of ectopic pregnancy: A retrospective case-control study. IJRM 2023; 21 (5) :403-414
URL: http://ijrm.ir/article-1-2534-en.html
Assessing the risk factors and management outcomes of ectopic pregnancy: A retrospective case-control study
Azadeh Tarfdari1 , Mahin Bandarian2 , Sedigheh Hantoushzadeh1 , Alireza Hadizadeh * 3, Saeedeh Shahsavari1 , Maryam alsadat Razavi1
1- Department of Obstetrics and Gynecology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
2- Department of Obstetrics and Gynecology, Ziaeian Hospital, Tehran University of Medical Sciences, Tehran, Iran.
3- Department of Obstetrics and Gynecology, Ziaeian Hospital, Tehran University of Medical Sciences, Tehran, Iran. , Ali1375hadi@gmail.com
Abstract:   (764 Views)
Background: Ectopic pregnancy (EP) is the implantation of a fertilized egg outside the uterine cavity or in an unusual location. According to the clinical case reports, hormonal contraceptive failures may be related to emergency contraceptives and EP. EP may be treated medically, surgically, or expectantly. Currently, there is no consensus regarding whether a multiple- or double-dose regimen with methotrexate (MTX) or an additional dose could be more effective than a single-dose regimen.
Objective: This study aimed to assess risk factors and treatment outcomes for EP.
Materials and Methods: This case-control study was carried out in Tehran, Iran from March 2020-March 2021. The case group was comprised of all EP-diagnosed cases (n = 191). Based on the levels of β-human chorionic gonadotropin, MTX was administered to stable individuals with no surgical indications. Risk factors were assessed through 2 control groups: intrauterine pregnancy (n = 190) and nonpregnant groups (n = 180).
Results: The medical treatment significantly improved with an extra dose of MTX, especially in individuals with higher β-human chorionic gonadotropin concentrations and gestational age > 7.5 wk (p = 0.002). Considering risk factors, it is assumed that hormonal contraceptive failures, including both oral and emergency contraceptives, may increase the EP likelihood (p < 0.001).
Conclusion: Based on our findings, we recommended an additional dose of MTX for subjects who are further along in their pregnancy. It is also concluded that failure of contraceptive pills increases the chances of EP.
Keywords: Contraception, Ectopic pregnancy, Intrauterine device, Levonorgestrel.
Full-Text [PDF 338 kb]   (644 Downloads) |   |   Full-Text (HTML)  (248 Views)  
Type of Study: Original Article | Subject: Pregnancy Health
References
1. Yang C, Cai J, Geng Y, Gao Y. Multiple-dose and double-dose versus single-dose administration of methotrexate for the treatment of ectopic pregnancy: A systematic review and meta-analysis. Reprod Biomed Online 2017; 34: 383-391. [DOI:10.1016/j.rbmo.2017.01.004] [PMID]
2. Glenn TL, Bembry J, Findley AD, Yaklic JL, Bhagavath B, Gagneux P, et al. Cesarean scar ectopic pregnancy: Current management strategies. Obstet Gynecol Surv 2018; 73: 293-302. [DOI:10.1097/OGX.0000000000000561] [PMID]
3. Timor-Tritsch IE, Monteagudo A, Calì G, D'Antonio F, Agten AK. Cesarean scar pregnancy: Patient counseling and management. Obstet Gynecol Clin 2019; 46: 813-828. https://doi.org/10.1016/j.ogc.2019.07.009 [DOI:10.1016/j.ogc.2019.07.010] [PMID]
4. Fowler ML, Wang D, Chia V, Handal-Orefice R, Latortue-Albino P, Mulekar S, et al. Management of cervical ectopic pregnancies: A scoping review. Obstet Gynecol 2021; 138: 33-41. [DOI:10.1097/AOG.0000000000004423] [PMID]
5. Timor-Tritsch I, Buca D, Di Mascio D, Cali G, D'Amico A, Monteagudo A, et al. Outcome of cesarean scar pregnancy according to gestational age at diagnosis: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2021; 258: 53-59. [DOI:10.1016/j.ejogrb.2020.11.036] [PMID]
6. Liu D, Yang M, Wu Q. Application of ultrasonography in the diagnosis and treatment of cesarean scar pregnancy. Clin Chim Acta 2018; 486: 291-297. [DOI:10.1016/j.cca.2018.08.012] [PMID]
7. Parashi S, Moukhah S, Ashrafi M. Main risk factors for ectopic pregnancy: A case-control study in a sample of Iranian women. Int J Fertil Steril 2014; 8: 147-154.
8. Barnhart KT. Ectopic pregnancy. New Engl J Med 2009; 361: 379-387. [DOI:10.1056/NEJMcp0810384] [PMID]
9. Cleland K, Raymond E, Trussell J, Cheng L, Zhu H. Ectopic pregnancy and emergency contraceptive pills: A systematic review. Obstet Gynecol 2010; 115: 1263-1266. [DOI:10.1097/AOG.0b013e3181dd22ef] [PMID] [PMCID]
10. Li C, Zhao W-H, Meng C-X, Ping H, Qin G-J, Cao S-J, et al. Contraceptive use and the risk of ectopic pregnancy: A multi-center case-control study. PloS One 2014; 9: e115031. [DOI:10.1371/journal.pone.0115031] [PMID] [PMCID]
11. Zhou XY, Li H, Fu XD. Identifying possible risk factors for cesarean scar pregnancy based on a retrospective study of 291 cases. J Obstet Gynaecol Res 2020; 46: 272-278. [DOI:10.1111/jog.14163] [PMID] [PMCID]
12. Callahan R, Yacobson I, Halpern V, Nanda K. Ectopic pregnancy with use of progestin-only injectables and contraceptive implants: A systematic review. Contraception 2015; 92: 514-522. [DOI:10.1016/j.contraception.2015.08.016] [PMID]
13. Zhang J, Li C, Zhao W-H, Xi X, Cao S-J, Ping H, et al. Association between levonorgestrel emergency contraception and the risk of ectopic pregnancy: A multicenter case-control study. Sci Rep 2015; 5: 8487. [DOI:10.1038/srep08487] [PMID] [PMCID]
14. Harb HM, Knight M, Bottomley C, Overton C, Tobias A, Gallos I, et al. Caesarean scar pregnancy in the UK: A national cohort study. BJOG 2018; 125: 1663-1670. https://doi.org/10.1111/1471-0528.15255 [DOI:10.1111/1471-0528.15325] [PMID]
15. Hasan M, Hasan FM, Zafar T. Ruptured scar pregnancy secondary to ingestion of misoprostol: A case report. Am J Sonography 2018; 1: 1. [DOI:10.25259/AJS-17-2018]
16. Webster K, Eadon H, Fishburn S, Kumar G. Ectopic pregnancy and miscarriage: Diagnosis and initial management: Summary of updated NICE guidance. BMJ 2019; 367: 6283. [DOI:10.1136/bmj.l6283] [PMID]
17. Elmokadem AH, Abdel-Wahab RM, El-Zayadi AA, Elrakhawy MM. Uterine artery embolization and methotrexate infusion as sole management for caesarean scar and cervical ectopic pregnancies: A single-center experience and literature review. Can Assoc Radiol J 2019; 70: 307-316. [DOI:10.1016/j.carj.2018.12.002] [PMID]
18. Pierce S, Bakker R, Myers DA, Edwards RK. Clinical insights for cervical ripening and labor induction using prostaglandins. AJP Rep 2018; 8: e307-e314. [DOI:10.1055/s-0038-1675351] [PMID] [PMCID]
19. Sindiani AM, Alshdaifat E, Obeidat B, Obeidat R, Rawashdeh H, Yaseen H. The use of single dose methotrexate in the management of ectopic pregnancy and pregnancy of unknown location: 10 years' experience in a tertiary center. Int J Women's Health 2020; 12: 1233-1239. [DOI:10.2147/IJWH.S279426] [PMID] [PMCID]
20. Hoover KW, Tao G, Kent CK. Trends in the diagnosis and treatment of ectopic pregnancy in the United States. Obstet Gynecol 2010; 115: 495-502. [DOI:10.1097/AOG.0b013e3181d0c328] [PMID]
21. Sivalingam VN, Duncan WC, Kirk E, Shephard LA, Horne AW. Diagnosis and management of ectopic pregnancy. J Fam Plann Reprod Health Care 2011; 37: 231-240. [DOI:10.1136/jfprhc-2011-0073] [PMID] [PMCID]
22. Farren J, Jalmbrant M, Falconieri N, Mitchell-Jones N, Bobdiwala S, Al-Memar M, et al. Posttraumatic stress, anxiety and depression following miscarriage and ectopic pregnancy: A multicenter, prospective, cohort study. Am J Obstet Gynecol 2020; 222: 367.e1-e22. [DOI:10.1016/j.ajog.2019.10.102] [PMID]
23. Barnhart KT, Gosman G, Ashby R, Sammel M. The medical management of ectopic pregnancy: A meta-analysis comparing "single dose" and "multidose" regimens. Obstet Gynecol 2003; 101: 778-784. https://doi.org/10.1097/00006250-200304000-00028 [DOI:10.1016/S0029-7844(02)03158-7] [PMID]
24. Morlando M, Buca D, Timor‐Tritsch I, Cali G, Palacios‐Jaraquemada J, Monteagudo A, et al. Reproductive outcome after cesarean scar pregnancy: A systematic review and meta‐analysis. Acta Obstet Gynecol Scand 2020; 99: 1278-1289. [DOI:10.1111/aogs.13918] [PMID]
25. Dior UP, Palma-Dias R, Reidy KL, Cheng C, Healey M. Cesarean scar pregnancies: Incidence and factors associated with conversion to surgery from medical management. J Minim Invasive Gynecol 2019; 26: 919-927. [DOI:10.1016/j.jmig.2018.09.771] [PMID]
26. Dziedzic JM, Patel PV. Cervical ectopic pregnancy: A rare site of implantation. J Emerg Med 2019; 56: e123-e125. [DOI:10.1016/j.jemermed.2019.03.024] [PMID]
27. Ashtari Kh, Nazari H, Ko H, Tebon P, Akhshik M, Akbari M, et al. Electrically conductive nanomaterials for cardiac tissue engineering. Adv Drug Deliv Rev 2019; 144: 162-179. [DOI:10.1016/j.addr.2019.06.001] [PMID] [PMCID]
28. Levine Y, Yahav L, Schwarzman P, Yohai D, Hershkovitz R, Weintraub AY. The correlation between endometrial thickness and the criteria for MTX treatment for ectopic pregnancy. J Obstet Gynaecol 2021; 41: 1230-1233. [DOI:10.1080/01443615.2020.1849068] [PMID]
29. Jauniaux E, Mavrelos D, De Braud LV, Dooley W, Knez J, Jurkovic D. Impact of location on placentation in live tubal and cesarean scar ectopic pregnancies. Placenta 2021; 108: 109-113. [DOI:10.1016/j.placenta.2021.03.019] [PMID]
30. Hüner B, Lato K, Reister F, Janni W, Deniz M. A scary complication: Single-center study on management and outcome of cesarean scar pregnancy. Rev Bras Ginecol Obstet 2021; 43: 311-316. [DOI:10.1055/s-0041-1728781] [PMID]
31. Zhang J, Zhang Y, Gan L, Liu X-Y, Du S-P. Predictors and clinical features of methotrexate (MTX) therapy for ectopic pregnancy. BMC Pregnancy Childbirth 2020; 20: 654. [DOI:10.1186/s12884-020-03350-8] [PMID] [PMCID]
32. Li H, Liu Y, Wen S, Jia H, Du Y. Evaluation of serum biomarkers and efficacy of MTX in women with ectopic pregnancy. Mol Med Rep 2019; 20: 2902-2908. [DOI:10.3892/mmr.2019.10533] [PMID]
33. Orhan A, Kasapoğlu I, Demir BÇ, Özerkan K, Duzok N, Uncu G. Different treatment modalities and outcomes in cesarean scar pregnancy: A retrospective analysis of 31 cases in a unıversity hospital. Ginekol Pol 2019; 90: 291-307. [DOI:10.5603/GP.2019.0053] [PMID]
34. Hendriks E, Rosenberg R, Prine L. Ectopic pregnancy: Diagnosis and management. Am Fam Physician 2020; 101: 599-606.
35. Guvendag Guven ES, Dilbaz S, Dilbaz B, Aykan Yildirim B, Akdag D, Haberal A. Comparison of single and multiple dose methotrexate therapy for unruptured tubal ectopic pregnancy: A prospective randomized study. Acta Obstet Gynecol Scand 2010; 89: 889-895. [DOI:10.3109/00016349.2010.486825] [PMID]
36. Tarafdari A, Malek M, Pahlevan Falahy E, Hadizadeh A. IUD perforation and embedment within omentum: A rare and perplexing incidence. Clin Case Rep 2022; 10: e05732. [DOI:10.1002/ccr3.5732] [PMID] [PMCID]
Send email to the article author

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

Designed & Developed by : Yektaweb