Overview and guidelines of off-label use of methotrexate in ectopic pregnancy: report by CNGOF

被引：40

作者：

Marret, Henri ^{[1
,2
,10
]}

Fauconnier, Arnaud ^{[3
,4
,10
]}

Dubernard, Gil ^{[5
,10
]}

Misme, Helene ^{[5
,10
]}

Lagarce, Laurence ^{[6
,10
]}

Lesavre, Magali ^{[7
,10
]}

Fernandez, Herve ^{[7
,10
]}

Mimoun, Camille ^{[3
,4
,10
]}

Tourette, Claire ^{[8
,10
]}

Curinier, Sandra ^{[9
,10
]}

Rabishong, Benoit ^{[9
,10
]}

Agostini, Aubert ^{[8
,10
]}

机构：

[1] CHU Tours, Hop Bretonneau, Fac Med Tours, Blvd Tonnelle, F-37044 Tours 1, France

[2] Univ Tours, UMR Inserm U930, 2 Blvd Tonnelle, F-37044 Tours 9, France

[3] Univ Versailles St Quentin, Unite Rech EA 7285, 2 Ave Source Bievre, F-78180 Montigny Le Bretonneux, France

[4] Ctr Hosp Intercommunal Poissy St Germain En Laye, Serv Gynecol & Obstet, 10 Rue Champ Gaillard,BP 3082, F-78303 Poissy, France

[5] Univ Lyon 1, Hosp Civils Lyon, Hop Croix Rousse, Serv Gynecol Obstet, 103 Grande Rue Croix Rousse, F-69004 Lyon, France

[6] CHU Angers, Ctr Reg Pharmacovigilance, 4 Rue Larmy, F-49933 Angers 9, France

[7] CHU Kremlin Bicetre, Serv Gynecol Obstet, 78 Ave Gen Leclerc, F-94276 Le Kremlin Bicetre, France

[8] Ctr Hosp Univ Marseille, Hop Concept, Pole Gynecol Obstet, 147 Blvd Bailie, F-13005 Marseille, France

[9] CHU Estaing, Serv Gynecol Obstet & Med Reprod, 1 Pl Lucie Aubrac, F-63003 Clermont Ferrand, France

[10] CNGOF, 91 Blvd Sebastopol, F-75002 Paris, France

来源：

EUROPEAN JOURNAL OF OBSTETRICS & GYNECOLOGY AND REPRODUCTIVE BIOLOGY | 2016年 / 205卷

关键词：

Methotrexate; Ectopic pregnancy; Interstitial pregnancy; hCG; Cervical pregnancy; Guideline; SINGLE-DOSE METHOTREXATE; HUMAN CHORIONIC-GONADOTROPIN; UNKNOWN LOCATION; SYSTEMIC METHOTREXATE; EXPECTANT MANAGEMENT; MEDICAL-TREATMENT; PREDICTIVE SCORE; WOMEN; SALPINGOSTOMY; METAANALYSIS;

D O I：

10.1016/j.ejogrb.2016.07.489

中图分类号：

R71 [妇产科学];

学科分类号：

100211 ;

摘要：

Our objective is to describe off-label use of methotrexate in ectopic pregnancy treatment using evidence based medicine. The patient group includes all women with a pregnancy outside the usual endometrium, or of unknown location. Method used was a Medline search on ectopic pregnancy managed using methotrexate treatment; evidence synthesis was done based on this current literature analysis. Level of evidence (LE) were given according to the centre for evidence base medicine rules. Grade was proposed for guidelines but no recommendation was possible as misoprostol is off label use for all the indications studied. In the absence of any contraindication, the protocol recommended for medical treatment of ectopic pregnancy is a single intramuscular injection of methotrexate (MTX) at a dosage of 1 mg/kg or 50 mg/m(2) (Grade A). It can be repeated once at the same dose should the hCG concentration not fall sufficiently. Pretreatment laboratory results must include a complete blood count and kidney and liver function tests (in accordance with its marketing authorization). MTX is an alternative to conservative treatment such as laparoscopic salpingotomy for uncomplicated tubal pregnancy (Grade A) with pretreatment hCG levels <= 5000 IU/1(Grade B). Expectant management is preferred for hCG levels < 1000 IU/I or in the process of spontaneous decreasing (Grade B). Intramuscular MTX is also recommended after the failure of surgical salpingotomy (Grade C) or immediately after surgery, if monitoring is not possible. Except in special circumstances, a local insitu ultrasound-guided MTX injection is not recommended for unruptured tubal pregnancies (Grade B). In situ MTX is an option for treating cervical, interstitial, or cesarean-scar pregnancies (Grade C).. In pregnancies of unknown location persisting more than 10 days in an asymptomatic woman who has an hCG level > 20001U/1, routine MTX treatment is an option. MTX is not indicated for combination with treatments such as mifepristone or potassium. (C) 2016 Published by Elsevier Ireland Ltd.

引用

页码：105 / 109

页数：5