DOI: https://doi.org/10.18370/2309-4117.2019.49.54-57

Some aspects of drug treatment of ectopic pregnancy

А. В. Бойчук, Ю. Б. Якимчук, В. І. Коптюх, О. І. Хлібовська

Abstract


Background. Today drug treatment of tubal pregnancy with methotrexate is a real alternative to endoscopic salpingectomy in patients who have not realized their reproductive function. This article presents a statistical analysis of clinical data based on the case histories of patients with ectopic pregnancy who were treated in Ternopil municipal hospital №2 for 2010–2017.

Objective of the study was to determine the homocysteine, folic acid, alkalinephosphatase, aspartate aminotransferase, alanine aminotransferase, common bilirubin levels in patients with progressive ectopic pregnancy, treated with different doses of methotrexate.

Materials and methods. Group I (30 women) included patients with an ectopic pregnancy who were treated intramuscularly with methotrexate (100–75 mg) once, and patients of group II (30 women) received additional 100–75 mg of methotrexate after 7 days. The control group consisted of 30 healthy women.

Results of the study. Twice administration of methotrexate at 7th day leads significant transient increase of aspartate aminotransferase, alanine aminotransferase and alkaline phosphatase. Once-daily use of methotrexate has no cytolytic effect on the liver cells, does not change the alkaline phosphatase and total bilirubin level. Homocysteine in the blood plasma for both 7th and 30th days increased with the use of the dose-dependent methotrexate. The folic acid level on the background of the methotrexate is significantly decreased.

Conclusions. Patients with progressive ectopic pregnancy with its accurate diagnosis should be offered conservative drug treatment, which will preserve the reproductive function of women in the future. In women who underwent medical treatment with cytostatic it is recommended the obligatory control of blood biochemical parameters and evaluation of homocysteine, folic acid

as factors that are clinically significant and may indicate a violation of the folate exchange. Folic acid recommended throughout the period of the preparation for next pregnancy to normalize laboratory parameters

Keywords


ectopic pregnancy; homocysteine; folic acid; methotrexate

References


Bodur, S., Gun, I., Guido, R. “What is the role of primary methotrexate treatment in scar ectopic pregnancy?” Am J Obstet Gynecol 210.4 (2014): 379–80. DOI: 10.1016/j.ajog.2014.01.027

Willner, N., Storch, S., Tadmor, T., Schiff, E. “Almost a tragedy: severe methotrexate toxicity in a hemodialysis patient treated for ectopic pregnancy.” Eur J Clin Pharmacol 70.3 (2014): 261–3. DOI: 10.1007/s00228-013-1608-3

Boychuk, A., Yakymchuk, Y. “Results of operative and conservative metods of treatment ectopic pregnancies.” Actual Problems of Pediatry, Obstetrics and Gynecology 2 (2016). DOI:10.11603/24116-4944.2016.2.6857

Boychuk, A.V., Yakymchuk, Yu.B., Yakymchuk, O.M. Violation of homocysteine exchange in conservative treatment of ectopic pregnancy. Collection of scientific papers of the Association of Obstetricians-gynecologists of Ukraine. Kyiv. Polygraph plus (2014): 354 p.

Boychuk, A., Kurylo, O.U., Tolokova, T. “Prevention of Adhesions in The Preservation of Reproductive Health of Women with Endometryoid Cysts.” Rec J Pharm Biol Chem Sci 8.3 (2017): 1447–54.

Cohen, A., Zakar, L., Gil, Y., et al. “Methotrexate success rates in progressing ectopic pregnancies: a reappraisal.” Am J Obstet Gynecol 211.2 (2014): 128.e1-5. DOI:10.1016/j.ajog.2014.03.043

Tong, S., Skubisz, M.M., Horne, A.W. “Molecular diagnostics and therapeutics for ectopic pregnancy.” Mol Hum Reprod 21.2 (2015): 126–35. DOI:10.1093/molehr/gau084

Brady, P.C. “New Evidence to Guide Ectopic Pregnancy Diagnosis and Management.” Obstet Gynecol Surv 72.10 (2017): 618–25. DOI:10.1097/OGX.0000000000000492

Talwar, P., Sandeep, K., Naredi, N., et al. “Systemic methotrexate: An effective alternative to surgery for management of unruptured ectopic pregnancy.” Med J Armed Forces India 69.2 (2013): 130–33. DOI: 10.1016/j.mjafi.2012.08.032

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Ratan, S.K., et al. “Evaluation of the levels of folate, vitamin B12, homocysteine and fluoride in the parents and the affected neonates with neural tube defect and their matched controls.” Pediatr Surg Int 24 (2008): 803–8.

Rozen, R. “Genetic predisposition to hyperhomocysteinemia: deficiency of methylenetetrahydrofolatereductase (MTHFR).” Thromb Haemost 78 (1997): 523–6.

Silaste, M.L., Rantala, M., Sampi, M., et al. “Polymorphisms of key enzymes in homocysteine metabolism affect diet responsiveness of plasma homocysteine in healthy women.” J Nutr 131 (2001): 2643–7.


GOST Style Citations


1.         Bodur, S., Gun, I., Guido, R. “What is the role of primary methotrexate treatment in scar ectopic pregnancy?” Am J Obstet Gynecol 210.4 (2014): 379–80. DOI: 10.1016/j.ajog.2014.01.027

2.         Willner, N., Storch, S., Tadmor, T., Schiff, E. “Almost a tragedy: severe methotrexate toxicity in a hemodialysis patient treated for ectopic pregnancy.” Eur J Clin Pharmacol 70.3 (2014): 261–3. DOI: 10.1007/s00228-013-1608-3

3.         Boychuk, A., Yakymchuk, Y. “Results of operative and conservative metods of treatment ectopic pregnancies.” Actual Problems of Pediatry, Obstetrics and Gynecology 2 (2016). DOI:10.11603/24116-4944.2016.2.6857

4.         Boychuk, A.V., Yakymchuk, Yu.B., Yakymchuk, O.M. Violation of homocysteine exchange in conservative treatment of ectopic pregnancy. Collection of scientific papers of the Association of Obstetricians-gynecologists of Ukraine. Kyiv. Polygraph plus (2014): 354 p.

5.         Boychuk, A., Kurylo, O.U., Tolokova, T. “Prevention of Adhesions in The Preservation of Reproductive Health of Women with Endometryoid Cysts.” Rec J Pharm Biol Chem Sci 8.3 (2017): 1447–54.

6.         Cohen, A., Zakar, L., Gil, Y., et al. “Methotrexate success rates in progressing ectopic pregnancies: a reappraisal.” Am J Obstet Gynecol 211.2 (2014): 128.e1-5. DOI:10.1016/j.ajog.2014.03.043

7.         Tong, S., Skubisz, M.M., Horne, A.W. “Molecular diagnostics and therapeutics for ectopic pregnancy.” Mol Hum Reprod 21.2 (2015): 126–35. DOI:10.1093/molehr/gau084

8.         Brady, P.C. “New Evidence to Guide Ectopic Pregnancy Diagnosis and Management.” Obstet Gynecol Surv 72.10 (2017): 618–25. DOI:10.1097/OGX.0000000000000492

9.         Talwar, P., Sandeep, K., Naredi, N., et al. “Systemic methotrexate: An effective alternative to surgery for management of unruptured ectopic pregnancy.” Med J Armed Forces India 69.2 (2013): 130–33. DOI: 10.1016/j.mjafi.2012.08.032

10.       Маркін, Л.Б., Матвієнко, О.О., Маркін, С.Л. Позаматкова вагітність. – Львів, 1999. – 106 с.

11.       Perez, A.B., D'Almeida, V., Vergani, N., et al. “Methylenetetrahydrofolatereductase (MTHFR): incidence of mutations C677T and A1298C in Brazilian population and its correlation with plasma homocysteine levels in spina bifida.” Am J Med Genet 119A (2003): 20–5.

12.       Ratan, S.K., et al. “Evaluation of the levels of folate, vitamin B12, homocysteine and fluoride in the parents and the affected neonates with neural tube defect and their matched controls.” Pediatr Surg Int 24 (2008): 803–8.

13.       Rozen, R. “Genetic predisposition to hyperhomocysteinemia: deficiency of methylenetetrahydrofolatereductase (MTHFR).” Thromb Haemost 78 (1997): 523–6.

14.       Silaste, M.L., Rantala, M., Sampi, M., et al. “Polymorphisms of key enzymes in homocysteine metabolism affect diet responsiveness of plasma homocysteine in healthy women.” J Nutr 131 (2001): 2643–7.




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