Effect of Methotrexate on Salpingostomy Completion Rate for Tubal Ectopic Pregnancy: A Retrospective Cohort Study.

Abstract:

STUDY OBJECTIVE:To determine whether completion rates of salpingostomy for tubal ectopic pregnancy are compromised by initial medical management with methotrexate (MTX). DESIGN:Retrospective cohort study. SETTING:Single academic hospital system. PATIENTS:Patients requiring surgery for ectopic pregnancy between 2006 and 2017. INTERVENTIONS:A subset of patients who went directly to surgery, and all patients who failed MTX before requiring surgery underwent detailed chart review. Salpingostomy plan and success rate and salpingostomy failure reasons were compared between patients pretreated with MTX and those who were MTX-untreated. MEASUREMENTS AND MAIN RESULTS:Among 94 ectopic pregnancies requiring surgery after failed MTX treatment, 55 (59%) underwent planned salpingostomy. From 693 ectopic pregnancies managed without MTX, 166 were analyzed in detail, of which 80 (48%) underwent planned salpingostomy. The patients who underwent planned salpingostomy were thinner (body mass index 27.3 ± 7.2 kg/m2 vs 29.3 ± 8.3 kg/m2; p = .048), less frequently African American (33% vs 47%; p = .017), and more likely to have a visualized adnexal lesion (70% vs 52%; p = .004) than those undergoing planned salpingectomy. Preoperative ultrasound identified fetal cardiac activity and hemoperitoneum at comparable rates. MTX exposure was not associated with age, body mass index, race, ectopic risk factors, human chorionic gonadotropin levels, or gestational age at diagnosis, but the patients treated with MTX underwent surgery later than those who were untreated (gestational age 53.4 ± 11.2 days vs 43.5 ± 11 days; p <.001). The differences between the adnexal lesion size and rates of fetal cardiac activity and hemoperitoneum on ultrasound related to MTX exposure did not meet significance. Planned salpingostomy was completed in 22 (40%) of the patients treated with MTX vs 34 (42%) of those who were untreated. The reasons for failure, surgery time, and rates of hemoperitoneum or ectopic rupture were not associated with MTX exposure. Body mass index, race, tubal anastomosis history, visualization of the adnexal lesion, and MTX exposure were not significantly associated with the salpingostomy rate in a multivariate logistic regression model, but having a subspecialist surgeon (odds ratio 2.70; 95% confidence interval, 1.08-6.76; p = .033) and tubal rupture at surgery (odds ratio 0.23; 95% confidence interval, 0.09-0.54; p = .001) were. CONCLUSION:The initial medical management of an ectopic pregnancy with MTX is not associated with a decreased salpingostomy success rate.

authors

Gingold JA,Janmey I,Gemmell L,Mei L,Falcone T

doi

10.1016/j.jmig.2020.09.003

subject

Has Abstract

pub_date

2020-09-07 00:00:00

eissn

1553-4650

issn

1553-4669

pii

S1553-4650(20)30881-5

pub_type

杂志文章
  • Clinical characteristics of adnexal masses in Korean children and adolescents: retrospective analysis of 409 cases.

    abstract:STUDY OBJECTIVE:To analyze the clinical characteristics of young Korean female children and adolescents who underwent surgery because of adnexal masses during the last 14 years. DESIGN:Retrospective cohort study (Canadian Task Force classification II-2). SETTING:University hospital. PATIENTS:Three hundred ninety-six...

    journal_title:Journal of minimally invasive gynecology

    pub_type: 杂志文章

    doi:10.1016/j.jmig.2009.12.013

    authors: Ryoo U,Lee DY,Bae DS,Yoon BK,Choi D

    更新日期:2010-03-01 00:00:00

  • Pentoxifylline therapy after laparoscopic surgery for different stages of endometriosis: a prospective, double-blind, randomized, placebo-controlled study.

    abstract:STUDY OBJECTIVE:To evaluate the effects of pentoxifylline administration on patients with different stages of endometriosis on whom laparoscopy was performed. DESIGN:Prospective, double-blind, randomized, placebo-controlled clinical (Canadian Task Force classification I). SETTING:University and private hospitals. PA...

    journal_title:Journal of minimally invasive gynecology

    pub_type: 杂志文章,随机对照试验

    doi:10.1016/j.jmig.2006.06.024

    authors: Alborzi S,Ghotbi S,Parsanezhad ME,Dehbashi S,Alborzi S,Alborzi M

    更新日期:2007-01-01 00:00:00

  • Endoscopic inguinal lymphadenectomy with a novel abdominal approach to vulvar cancer: description of technique and surgical outcome.

    abstract:STUDY OBJECTIVE:To evaluate the feasibility and surgical outcome of a novel technique of endoscopic inguinal lymphadenectomy to treat vulvar cancer. DESIGN:Retrospective analysis performed by a single center over 2 years (Canadian Task Force classification II-2). SETTING:Major university teaching hospital. PATIENTS:...

    journal_title:Journal of minimally invasive gynecology

    pub_type: 杂志文章

    doi:10.1016/j.jmig.2011.06.011

    authors: Xu H,Wang D,Wang Y,Li Y,Chen Y,Liang Z

    更新日期:2011-09-01 00:00:00

  • Providing Re-Essure-ance to the Nickel-Allergic Patient Considering Hysteroscopic Sterilization.

    abstract::Essure is a popular method of permanent sterilization that offers a minimally invasive approach that avoids the risks of traditional sterilization procedures in the operating room. Despite the rarity of complications, there has been concern in the popular media over the safety of Essure. We describe the third reported...

    journal_title:Journal of minimally invasive gynecology

    pub_type: 杂志文章

    doi:10.1016/j.jmig.2015.07.020

    authors: Lane A,Tyson A,Thurston E

    更新日期:2016-01-01 00:00:00

  • Myoma Imaging by Gynecologic Surgeons Training in Intraoperative Ultrasound Technique.

    abstract:STUDY OBJECTIVE:To compare preoperative transvaginal ultrasound (TVUS) and magnetic resonance imaging (MRI) with intraoperative ultrasound (IOUS) in surgeons first learning to use this technique. DESIGN:A prospective study of IOUS accuracy for mapping the size and location of myomas compared with TVUS or MRI (Canadian...

    journal_title:Journal of minimally invasive gynecology

    pub_type: 临床试验,杂志文章,多中心研究

    doi:10.1016/j.jmig.2018.11.006

    authors: Bent RE,Wilson MD,Jacoby VL,Varon S,Parvataneni R,Saberi N,Waetjen LE

    更新日期:2019-01-01 00:00:00

  • Robotic Radical Hysterectomy Is Not Superior to Laparoscopic Radical Hysterectomy in Perioperative Urologic Complications: A Meta-Analysis of 23 Studies.

    abstract:OBJECTIVE:This study aimed to compare the risks of intraoperative and postoperative urologic complications after robotic radical hysterectomy (RRH) compared with laparoscopic radical hysterectomy (LRH). DATA SOURCES:We searched Pubmed, EMBASE, and the Cochrane Library for studies published up to March 2019. Related ar...

    journal_title:Journal of minimally invasive gynecology

    pub_type: 杂志文章,meta分析

    doi:10.1016/j.jmig.2019.07.008

    authors: Hwang JH,Kim BW,Kim SR,Kim JH

    更新日期:2020-01-01 00:00:00

  • A comparative study of hysteroscopic sterilization performed in-office versus a hospital operating room.

    abstract:STUDY OBJECTIVE:To compare hysteroscopic female sterilization procedures performed in-office versus a hospital operating room (OR) among newly trained physicians. DESIGN:Multisite hospital operating rooms and physician offices. PATIENTS:Women desiring permanent hysteroscopic sterilization. INTERVENTION:Hysteroscopic...

    journal_title:Journal of minimally invasive gynecology

    pub_type: 杂志文章,多中心研究

    doi:10.1016/j.jmig.2006.05.014

    authors: Nichols M,Carter JF,Fylstra DL,Childers M,Essure System U.S. Post-Approval Study Group.

    更新日期:2006-09-01 00:00:00

  • Spontaneous cornual pregnancy after homolateral salpingectomy for an earlier tubal pregnancy: a case report and literature review.

    abstract::Cornual pregnancy is an infrequent pathological condition with severe prognosis if not adequately recognized. Ipsilateral salpingectomy represents a unique risk factor for this clinical entity. This article reports a laparoscopically treated spontaneous cornual pregnancy after homolateral salpingectomy for an earlier ...

    journal_title:Journal of minimally invasive gynecology

    pub_type: 杂志文章,评审

    doi:10.1016/j.jmig.2008.11.008

    authors: Pluchino N,Ninni F,Angioni S,Carmignani A,Genazzani AR,Cela V

    更新日期:2009-03-01 00:00:00

  • Comparison of Carbon Dioxide Absorption Rates in Gynecologic Laparoscopy with a Valveless versus Standard Insufflation System: Randomized Controlled Trial.

    abstract:STUDY OBJECTIVE:The primary objective was to compare carbon dioxide (CO2) absorption rates in patients undergoing gynecologic laparoscopy with a standard versus valveless insufflation system (AirSeal; ConMed, Utica, NY) at intra-abdominal pressures (IAPs) of 10 and 15 mm Hg. Secondary objectives were assessment of surg...

    journal_title:Journal of minimally invasive gynecology

    pub_type: 杂志文章,随机对照试验

    doi:10.1016/j.jmig.2019.05.005

    authors: Madueke-Laveaux OS,Advincula A,Grimes CL,Walters R,Kim JH,Simpson K,Truong M,Young C,Landau R,Ryntz T

    更新日期:2020-01-01 00:00:00

  • Transvaginal Natural Orifice Transluminal Endoscopic Surgery as a Rescue for Total Vaginal Hysterectomy.

    abstract:BACKGROUND:Transvaginal surgery is the most minimally invasive surgery for a gynecologic procedure but can be challenging for many to perform as evidenced by its declining rate. Vaginal removal of the adnexal structures can be difficult because of poor visualization. Factors such as abnormal pathology, incidental findi...

    journal_title:Journal of minimally invasive gynecology

    pub_type: 杂志文章

    doi:10.1016/j.jmig.2018.01.028

    authors: Guan X,Bardawil E,Liu J,Kho R

    更新日期:2018-01-01 00:00:00

  • Postoperative adhesions as a consequence of pelvic surgery.

    abstract::Adhesions represent a frequent thought-provoking surgical ramification that greatly affects clinical practice, thereby making adhesion deterrence an important area of public health intervention, research, and the fiscal budget. Postoperative adhesions have been observed in up to 94% of patients after laparotomy. Adhes...

    journal_title:Journal of minimally invasive gynecology

    pub_type: 杂志文章,评审

    doi:10.1016/j.jmig.2014.12.009

    authors: Bolnick A,Bolnick J,Diamond MP

    更新日期:2015-05-01 00:00:00

  • Power Morcellator Features Affecting Tissue Spill in Gynecologic Laparoscopy: An In-Vitro Study.

    abstract:STUDY OBJECTIVE:To assess features of power morcellators (blade diameter, circular vs oscillating cutting, blade rotation speed, experience level) regarding their effect on the amount of tissue spill. In addition, the amount of tissue spill after the initial two-thirds and final one-third of the morcellated specimen wa...

    journal_title:Journal of minimally invasive gynecology

    pub_type: 杂志文章

    doi:10.1016/j.jmig.2015.09.014

    authors: van den Haak L,Arkenbout EA,Sandberg EM,Jansen FW

    更新日期:2016-01-01 00:00:00

  • A Systematic Review of Perioperative Opioid Management for Minimally Invasive Hysterectomy.

    abstract::Excessive opioid use and misuse is a pervasive and growing societal problem, and decreasing the surgical contribution to this epidemic represents an opportunity to improve outcomes. Here we describe patterns of opioid prescription, consumption, and persistent use among women undergoing minimally invasive hysterectomy ...

    journal_title:Journal of minimally invasive gynecology

    pub_type: 杂志文章

    doi:10.1016/j.jmig.2018.08.024

    authors: Johnson CM,Makai GEH

    更新日期:2019-02-01 00:00:00

  • Laparoscopy as the most effective tool for management of postmenopausal complex adnexal masses when expectancy is not advisable.

    abstract::Postmenopausal women with adnexal masses suspicious for malignancy must undergo surgery for histopathologic confirmation. The low positive predictive value for malignancy of the currently available preoperative examinations results in 5 to 220 surgeries performed for each case of pelvic malignancy detected, depending ...

    journal_title:Journal of minimally invasive gynecology

    pub_type: 杂志文章,评审

    doi:10.1016/j.jmig.2012.05.007

    authors: Zanatta A,Rosin MM,Gibran L

    更新日期:2012-09-01 00:00:00

  • Diagnosis and treatment of tubal diverticula: report of 13 cases.

    abstract::Tubal diverticula is a rare disease, and the literature includes only a few reports of this condition. We tentatively summarized 13 cases to investigate the clinical characteristics, diagnosis, and treatment of tubal diverticula. The clinical manifestations, diagnosis at hysterosalpingography (HSG), surgical treatment...

    journal_title:Journal of minimally invasive gynecology

    pub_type: 杂志文章

    doi:10.1016/j.jmig.2013.05.022

    authors: Han H,Guan J,Wang Y,Zhang Q,Shen H

    更新日期:2014-01-01 00:00:00

  • Analysis of Reported Adverse Events with Uterine Artery Embolization for Leiomyomas.

    abstract:STUDY OBJECTIVE:To analyze and investigate reports associated with uterine artery embolization used for treatment of myomas using this database. DESIGN:A retrospective review of the Manufacturer and User Facility Device Experience (MAUDE) database for events related to uterine artery embolization (Canadian Task Force ...

    journal_title:Journal of minimally invasive gynecology

    pub_type: 杂志文章

    doi:10.1016/j.jmig.2018.07.006

    authors: Armstrong AA,Kroener L,Brower M,Al-Safi ZA

    更新日期:2019-01-01 00:00:00

  • Impact of Ultrasound-Guided Transvaginal Ovarian Needle Drilling Versus Laparoscopic Ovarian Drilling on Ovarian Reserve and Pregnancy Rate in Polycystic Ovary Syndrome: A Randomized Clinical Trial.

    abstract:STUDY OBJECTIVE:To compare the impact of ultrasound-guided transvaginal ovarian needle drilling (TND) versus laparoscopic ovarian drilling (LOD) on ovarian reserve and pregnancy rate in patients with clomiphene citrate (CC)-resistant polycystic ovary syndrome (PCOS). DESIGN:A randomized clinical trial (Canadian Task F...

    journal_title:Journal of minimally invasive gynecology

    pub_type: 杂志文章,随机对照试验

    doi:10.1016/j.jmig.2018.01.036

    authors: Kandil M,Rezk M,Al-Halaby A,Emarh M,El-Nasr IS

    更新日期:2018-01-01 00:00:00

  • Evaluation and treatment of menorrhagia in an adolescent population.

    abstract::Bleeding in adolescence is a common but, potentially, difficult condition to manage. Adolescents present with unique issues related to their age, involvement of family members, different differential diagnosis when compared to an older populations, and challenges associated with their evaluation and treatment. ...

    journal_title:Journal of minimally invasive gynecology

    pub_type: 杂志文章

    doi:10.1016/j.jmig.2008.08.014

    authors: Frishman GN

    更新日期:2008-11-01 00:00:00

  • Design and Preclinical Validation of the Composite-Type Optical Fiberscope for Minimally Invasive Procedures of Intrauterine Disease.

    abstract:STUDY OBJECTIVE:Because of the rapid growth of minimally invasive surgical procedures, we developed an ultrathin fiberscopic imaging system for laser surgery that could be an important instrument for clinical use in an office setting. METHODS AND MAIN RESULTS:A new device, consisting of a custom 1.1-mm diameter flexib...

    journal_title:Journal of minimally invasive gynecology

    pub_type: 杂志文章

    doi:10.1016/j.jmig.2015.04.024

    authors: Shigetomi H,Oka K,Seki T,Kobayashi H

    更新日期:2015-09-01 00:00:00

  • Complications Related to the Initial Trocar Insertion of 3 Different Techniques: A Systematic Review and Meta-analysis.

    abstract::This systematic review aimed to investigate complications related to initial trocar insertion among 3 different laparoscopic techniques: Veress needle (VN) entry, direct trocar entry (DTE), and open entry (OE). A literature search was completed, and complications were assessed. Major vessel injury, gastrointestinal in...

    journal_title:Journal of minimally invasive gynecology

    pub_type: 杂志文章,meta分析

    doi:10.1016/j.jmig.2018.06.023

    authors: Nishimura M,Matsumoto S,Ohara Y,Minowa K,Tsunematsu R,Takimoto K,Imai K,Tsuzuki Y,Ota H,Nakajima A,Fukushi Y,Wada S,Fujino T,Ito YM

    更新日期:2019-01-01 00:00:00

  • Nonsurgical transurethral collagen denaturation for stress urinary incontinence in women: 12-month results from a prospective long-term study.

    abstract:STUDY OBJECTIVE:To assess efficacy of nonsurgical transurethral collagen denaturation (Renessa) in women with stress urinary incontinence (SUI) caused by bladder outlet hypermobility. DESIGN:Continuing, prospective, 36-month, open-label, single-arm clinical trial. Twelve-month results from intent-to-treat (ITT) analys...

    journal_title:Journal of minimally invasive gynecology

    pub_type: 临床试验,杂志文章,多中心研究

    doi:10.1016/j.jmig.2008.09.621

    authors: Elser DM,Mitchell GK,Miklos JR,Nickell KG,Cline K,Winkler H,Wells WG

    更新日期:2009-01-01 00:00:00

  • Comparison of perioperative outcomes and cost between robotic-assisted and conventional laparoscopy for transperitoneal infrarenal para-aortic lymphadenectomy (TIPAL).

    abstract:STUDY OBJECTIVE:To compare perioperative outcomes and cost of robotic-assisted and laparoscopic transperitoneal infrarenal para-aortic lymphadenectomy (TIPAL) for treatment of gynecologic malignant conditions. DESIGN:Prospective non-randomized study (Canadian Task Force classification II-2). SETTING:Tertiary center f...

    journal_title:Journal of minimally invasive gynecology

    pub_type: 临床试验,杂志文章

    doi:10.1016/j.jmig.2014.01.023

    authors: Coronado PJ,Fasero M,Magrina JF,Herraiz MA,Vidart JA

    更新日期:2014-07-01 00:00:00

  • Successful Management of Heterotopic Cervical Pregnancy with Ultrasonographic-guided Laser Ablation.

    abstract::Heterotopic pregnancy refers to the simultaneous presence of ectopic pregnancy and intrauterine pregnancy. With the advent of assisted reproductive technology, the overall incidence of heterotopic pregnancies has risen. We report a case of a 36-year-old woman with type 2 diabetes mellitus and 1-year of primary inferti...

    journal_title:Journal of minimally invasive gynecology

    pub_type: 杂志文章

    doi:10.1016/j.jmig.2019.11.003

    authors: Sepúlveda González G,Villagómez Martínez GE,Basurto Diaz D,Guerra de la Garza Evia ÁR,Rosales de León JC,Arroyo Lemarroy T,Soria López JA

    更新日期:2020-01-01 00:00:00

  • Transvaginal Excision of an Eroded Sacrocolpopexy Mesh by Using Single-Incision Laparoscopic Surgery Equipment.

    abstract:STUDY OBJECTIVE:To show a new technique of using single-incision laparoscopic surgery (SILS) equipment in vaginal surgery to create a "pneumovagina." DESIGN:Explanatory video demonstrating the technique and intraoperative findings. SETTING:University hospital. PATIENT:The 68-year-old patient was referred with a vagi...

    journal_title:Journal of minimally invasive gynecology

    pub_type: 杂志文章

    doi:10.1016/j.jmig.2017.04.001

    authors: Mohr S,Siegenthaler F,Imboden S,Kuhn A,Mueller MD

    更新日期:2017-01-01 00:00:00

  • Single-Use Energy Sources and Operating Room Time for Laparoscopic Hysterectomy: A Randomized Controlled Trial.

    abstract:STUDY OBJECTIVES:To compare the intraoperative direct costs of a single-use energy device with reusable energy devices during laparoscopic hysterectomy. DESIGN:A randomized controlled trial (Canadian Task Force Classification I). SETTING:An academic hospital. PATIENTS:Forty-six women who underwent laparoscopic hyste...

    journal_title:Journal of minimally invasive gynecology

    pub_type: 杂志文章,随机对照试验

    doi:10.1016/j.jmig.2015.08.881

    authors: Holloran-Schwartz MB,Gavard JA,Martin JC,Blaskiewicz RJ,Yeung PP Jr

    更新日期:2016-01-01 00:00:00

  • Impact of isthmocele on assisted reproductive treatment outcomes: an age-matched retrospective study.

    abstract:STUDY OBJECTIVE:To evaluate whether the presence of an ultrasonographic visible isthmocele has an impact on the chance of pregnancy in women undergoing embryo transfer. DESIGN:An age-matched retrospective study SETTING: Private assisted reproductive center PATIENTS: The study included a total of 150 patients with a pr...

    journal_title:Journal of minimally invasive gynecology

    pub_type: 杂志文章

    doi:10.1016/j.jmig.2020.10.002

    authors: Asoglu MR,Celik C,Ozturk E,Cavkaytar S,Bahceci M

    更新日期:2020-10-07 00:00:00

  • Infection during natural orifice transluminal endoscopic surgery peritoneoscopy: a randomized comparative study in a survival porcine model.

    abstract:BACKGROUND:Infection in natural orifice transluminal endoscopic surgery (NOTES) remains controversial. OBJECTIVE:To estimate the frequency of infection during NOTES peritoneoscopy with different routes of access and to compare with laparoscopy. DESIGN:Prospective randomized controlled study (Canadian Classification t...

    journal_title:Journal of minimally invasive gynecology

    pub_type: 杂志文章

    doi:10.1016/j.jmig.2011.08.001

    authors: Guarner-Argente C,Beltrán M,Martínez-Pallí G,Navarro-Ripoll R,Martínez-Zamora MÀ,Córdova H,Comas J,de Miguel CR,Rodríguez-D'Jesús A,Almela M,Hernández-Cera C,Lacy AM,Fernández-Esparrach G

    更新日期:2011-11-01 00:00:00

  • Transvaginal Natural Orifice Transluminal Endoscopic Surgery for Sacrocolpopexy: A Pilot Study of 26 Cases.

    abstract:STUDY OBJECTIVE:To describe the surgical technique and short-term outcomes for 26 cases of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) sacrocolpopexy for the treatment of pelvic organ prolapse (POP). DESIGN:Retrospective case series study (Canadian Task Force classification II-2). SETTING:Ac...

    journal_title:Journal of minimally invasive gynecology

    pub_type: 杂志文章

    doi:10.1016/j.jmig.2018.08.009

    authors: Liu J,Kohn J,Fu H,Guan Z,Guan X

    更新日期:2019-01-01 00:00:00

  • Hysteroscopic Intrauterine Adhesiolysis Using a Blunt Spreading Dissection Technique With Double-action Forceps.

    abstract:STUDY OBJECTIVE:To demonstrate step-by-step the technique of hysteroscopic adhesiolysis (HA) by means of a blunt spreading technique using double-action forceps to dissect and restore the layer between the anterior and posterior uterine walls in a patient with severe intrauterine adhesions (IUAs), particularly in cases...

    journal_title:Journal of minimally invasive gynecology

    pub_type: 杂志文章

    doi:10.1016/j.jmig.2017.10.011

    authors: Huang H,Cheng C,Johnson G,Wang R,Xue M,Zhang A,Xu D,Guan X

    更新日期:2018-01-01 00:00:00

  • Surgeon volume and outcomes in benign hysterectomy.

    abstract::Annual surgeon case volume has been linked to patient outcome in a variety of surgical fields, although limited data focus on gynecologic surgery performed by general gynecologists. Herein we review the literature addressing the associations between intraoperative injury, postoperative morbidity, and resource use amon...

    journal_title:Journal of minimally invasive gynecology

    pub_type: 杂志文章,评审

    doi:10.1016/j.jmig.2013.03.005

    authors: Doll KM,Milad MP,Gossett DR

    更新日期:2013-09-01 00:00:00