%0 Journal Article
%T The Value of Hysterosalpingography following Medical Treatment with Methotrexate for Ectopic Pregnancy
%A Emma Garcia Grau
%A Miguel ¨¢ngel Checa Vizca¨ªno
%A M¨¢rio Oliveira
%A Judith Lleberia Juan¨®s
%A Ramon Carreras Collado
%A Yolanda Canet Estevez
%J Obstetrics and Gynecology International
%D 2011
%I Hindawi Publishing Corporation
%R 10.1155/2011/547946
%X After an ectopic pregnancy (EP) fertility decreases, mostly due to tubal factor. Hysterosalpingography (HSG) is the most cost-effective tool for tubal patency assessment. Objective. To evaluate the usefulness of a HSG after a medical treatment for an EP, in order to counsel women on the most appropriate way to conceive future pregnancies. Methods. Between 1998 and 2008, 144 patients were submitted to medical treatment for an EP and performed HSG 3 months after the event. Results. 72.2% of normal HSG, 18.8% with unilateral obstruction, 6.3% tubal patency with defect, and 2.8% bilateral obstruction. Conclusion. Routine HSG following medical treatment for an EP does not seem necessary, as it does not change the initial management in 97.2% of the cases, but might be considered in selected risk cases, permitting timely referral of patients to in vitro fertilization. 1. Introduction Ectopic pregnancy (EP) is defined as the abnormal implantation of the blastocyst outside the uterine endometrium. It affects 2% of all pregnancies and is associated with significant maternal morbid mortality, being the main cause of maternal death during the first trimester of gestation [1]. The most common site of implantation is the Fallopian tube (in the fimbrial end, ampullary section, or isthmus) but can also be interstitial, ovarian, abdominal and cervical, or on the site of a previous cesarean section scar [2]. Females with abnormal Fallopian tubes are at increased risk of developing an EP [3]. Thus, the risk factors for developing EP include pelvic inflammatory disease (PID), history of EP, infertility, history of pelvic or abdominal surgery, endometriosis, sexually transmitted diseases, previous tubal surgery (namely tubal sterilization), smoking, older maternal age, and in uterus exposure to diethylstilbestrol. Some of these conditions result in scar tissue at the Fallopian tubes and may thus prevent the fertilized egg to reach the uterine cavity. Despite the fact that the treatment is classically surgical, early diagnosis allows the implementation of a medical treatment [4], thus avoiding the surgery-associated morbidity and maintaining the patient¡¯s anatomy. Several medical treatments have been used such as prostaglandins, dactinomycin, etoposide, hyperosmolar glucose, anti-hCG antibodies, potassium chloride, or mifepristone. However, the treatment with methotrexate (MTX) has shown better results and is presently considered the first option for medical therapy [5]. MTX is chemotherapeutic drug, antagonist of folic acid and acts as an antimetabolite, by combining with
%U http://www.hindawi.com/journals/ogi/2011/547946/