Management of various types of ectopic pregnancy – a questionnaire study

Česká verze

Authors: Barbora Švédová ; Martin Hruda ; Vít Drochýtek ; Michael Jiří Halaška ; Kateřina Maxová ; Nikola Janovská ; Helena Součková; Anna Babková ; Lukáš Rob ; Borek Sehnal
Authors place of work: Gynekologicko-porodnická klinika 3. LF UK a FNKV, Praha
Published in the journal: Ceska Gynekol 2025; 90(2): 141-148
Category: Původní práce
doi: https://doi.org/10.48095/cccg2025141

Summary

Objective: To map management of different types of ectopic pregnancies in the Czech Republic using a questionnaire-based study. Methods: In 2023, a total of 95 obstetrics and gynecology departments across the Czech Republic were surveyed using an online questionnaire, which inquired about the management strategies for various types of ectopic pregnancies. The departments were categorized based on the number of hysterectomies performed annually. Differences in responses between large centers and other departments were statistically compared. Results: A total of 45 departments of all sizes completed the questionnaire. Two-thirds of all departments always perform salpingectomy in cases of tubal pregnancy (78% of large, 58% of medium-sized, and 40% of small departments). Systemic methotrexate administration for the treatment of intact tubal pregnancy is used by one-fifth of departments (22% of large, 23% of medium-sized, and 0% of small departments). In cases of atypical ectopic pregnancy localization, methotrexate treatment is used by 33% of large, 42% of medium-sized, and 40% of small departments. A statistically significant difference was observed in the clearly preferred laparoscopic approach for surgical management of cesarean scar pregnancy in large centers compared to smaller departments (P = 0.036). No other statistically significant differences were observed between the departments in other parameters. Conclusion: In cases of intact tubal pregnancy, four-fifths of obstetric and gynecological departments perform laparoscopic salpingectomy, while only one-fifth utilize systemic methotrexate for treatment. On the other hand, methotrexate is used by one-third to two-fifths of departments of all sizes in cases of atypical ectopic pregnancy localization.

Keywords:

Methotrexate – Czech Republic – ectopic pregnancy – cesarean scar pregnancy – interstitial pregnancy – cervical pregnancy – questionnaire study – salpingostomy

Zdroje

1. Raine-Bennett T, Fassett MJ, Chandra M et al. Disparities in the incidence of ectopic pregnancy in a large health care system in California, 2010–2019. Perm J 2022; 26 (3): 61–68. doi: 10.7812/TPP/21.099.

2. Yazawa H, Yazawa R, Matsuoka R et al. Surgical outcomes and trends in incidence of ectopic pregnancy. Gynecol Minim Invasive Ther 2024; 13 (2): 111–118. doi: 10.4103/gmit.gmit_53_23.

3. Bouyer J, Coste J, Fernandez H et al. Sites of ectopic pregnancy: a 10 year population-based study of 1800 cases. Hum Reprod 2002; 17 (12): 3224–3230. doi: 10.1093/humrep/17.12.3224.

4. Hendriks E, Rosenberg R, Prine L. Ectopic pregnancy: diagnosis and management. Am Fam Physician 2020; 101 (10): 599–606.

5. Derbak A. Mimoděložní těhotenství v ultrazvukovém obraze. Kazuistiky. Retrospektivní analýza. Ceska Gynekol 2016; 81 (1): 63–70.

6. Mullany K, Minneci M, Monjazeb R et al. Overview of ectopic pregnancy diagnosis, management, and innovation. Womens Health (Lond) 2023; 19: 17455057231160349. doi: 10.1177/17455057231160349.

7. Kubešová B, Líbalová P, Simonová V et al. Retrospektivní analýza efektivity, diagnostiky ektopické gravidity transvaginálním ultrazvukovým vyšetřením. Ceska Gynekol 2013; 78 (4): 338–341.

8. Jar-Allah T, Hognert H, Köcher L et al. Detection of ectopic pregnancy and serum beta hCG levels in women undergoing very early medical abortion: a retrospective cohort study. Eur J Contracept Reprod Health Care 2022; 27 (3): 240–246. doi: 10.1080/13625187.2022.2025587.

9. Fischerova D, Paškova A, Břeťak M. Těhotenství neznámé lokalizace. In: Calda, P, Břešták M, Fischerova D (eds). Ultrazvuková diagnostika v těhotenství a gynekologii. 2. vyd. Praha: Aprofema 2010; 428–434.

10. Al Naimi A, Moore P, Brüggmann D et al. Ectopic pregnancy: a single-center experience over ten years. Reprod Biol Endocrinol 2021; 19 (1): 79. doi: 10.1186/s12958-021-00761-w.

11. Racková J, Driák D, Neumannová H et al. Použití metotrexátu u ektopické gravidity a tehotenství neznámé lokalizace. Ceska Gynekol 2016; 81 (2): 141–146.

12. Sehnal B, Hanáček J, Matěcha J et al. Fertilitu šetřící terapie u ektopické gravidity. Ceska Gynekol 2023; 88 (1): 20–26. doi: 10.48095/ cccg202320.

13. Bruhat MA, Pouly JL. Endoscopic treatment of ectopic pregnancies. Curr Opin Obstet Gynecol 1993; 5 (2): 260–266.

14. Zaremba R, Mára M, Razak I et al. Hysteroskopicky asistovaná laparoskopická salpingostomie při řešení tubární gravidity. Ceska Gynekol 2018; 83 (1): 50–52.

15. Cheng X, Tian X, Yan Z et al. Comparison of the fertility outcome of salpingotomy and salpingectomy in women with tubal pregnancy: a systematic review and meta-analysis. PLoS One 2016; 11 (3): e0152343. doi: 10.1371/journal.pone.0152343.

16. Mol F, van Mello NM, Strandell A et al. European Surgery in Ectopic Pregnancy (ESEP) study group. Salpingotomy versus salpingectomy in women with tubal pregnancy (ESEP study): an open-label, multicentre, randomised controlled trial. Lancet 2014; 383 (9927): 1483–1489. doi: 10.1016/S0140-6736 (14) 60123-9.

17. Ozcan MC, Wilson JR, Frishman GN. A systematic review and meta-analysis of surgical treatment of ectopic pregnancy with salpingectomy versus salpingostomy. J Minim Invasive Gynecol 2021; 28 (3): 656–667. doi: 10.1016/j.jmig.2020.10.014.

18. Zapletal J, Maxová K, Halaška MJ et al. Kompletní tubární potrat nevyžadující salpingektomii. Ceska Gynekol 2024; 89 (3): 210–214. doi: 10.48095/cccg2024210.

19. Elson CJ, Salim R, Potdar N et al. Diagnosis and management of ectopic pregnancy. BJOG 2016; 123 (13): e15–e55.

20. Bárta J, Klát J. Bilaterální tubární gravidita. Ceska Gynekol 2020; 85 (1): 15–17.

21. Botsyurko R, Smoligová V. Bilaterální tubární ektopická gravidita po spontánní koncepci. Ceska Gynekol 2023; 88 (4): 287–290. doi: 10.48095/cccg2023287.

22. Hamranová N, Hocinec N, Záhumenský J et al. Staré a nové pohľady na funkčnú morfológiu vajíčkovodov a ich význam pre gynekologickú prax. Ceska Gynekol 2023; 88 (1): 33–43. doi: 10.48095/cccg202333.

23. Hsu JY, Chen L, Gumer AR et al. Disparities in the management of ectopic pregnancy. Am J Obstet Gynecol 2017; 217 (1): 49.e1–49.e10. doi: 10.1016/j.ajog.2017.03.001.

24. Driák D, Sehnal B, Jarošová L et al. Perforace dělohy při nitroděložních výkonech a její řešení. Ceska Gynekol 2022; 87 (4): 295–301. doi: 10.48095/cccg2022295.

25. Guvendag Guven ES, Dilbaz S, Dilbaz B et al. Comparison of single and multiple dose methotrexate therapy for unruptured tubal ectopic pregnancy: a prospective randomized study. Acta Obstet Gynecol Scand 2010; 89 (7): 889–895. doi: 10.3109/00016349.2010.486825.

26. Nowak-Markwitz E, Michalak M, Olejnik M et al. Cutoff value of human chorionic gonadotropin in relation to the number of methotrexate cycles in the successful treatment of ectopic pregnancy. Fertil Steril 2009; 92 (4): 1203–1207. doi: 10.1016/j.fertnstert.2008.07.1775.

27. Solangon SA, Van Wely M, Van Mello N et al. Methotrexate vs expectant management for treatment of tubal ectopic pregnancy: an individual participant data meta-analysis. Acta Obstet Gynecol Scand 2023; 102 (9): 1159–1175. doi: 10.1111/aogs.14617.

28. Karavani G, Gutman-Ido E, Herzberg S et al. Recurrent tubal ectopic pregnancy management and the risk of a third ectopic pregnancy. J Minim Invasive Gynecol 2021; 28 (8): 1497.e1– –1502.e1. doi: 10.1016/j.jmig.2020.12.005.

29. Maheux-Lacroix S, Li F, Bujold E et al. Cesarean scar pregnancies: a systematic review of treatment options. J Minim Invasive Gynecol 2017; 24 (6): 915–925. doi: 10.1016/ j.jmig.2017.05.019.

30. Hung TH, Shau WY, Hsieh TT et al. Prognostic factors for an unsatisfactory primary methotrexate treatment of cervical pregnancy: a quantitative review. Hum Reprod 1998; 13 (9): 2636–2642. doi: 10.1093/humrep/13. 9.2636.

31. Timor-Tritsch IE, Monteagudo A. Unforeseen consequences of the increasing rate of cesarean deliveries: early placenta accreta and cesarean scar pregnancy. A review. Am J Obstet Gynecol 2012; 207 (1): 14–29. doi: 10.1016/j.ajog.2012.03.007.

32. Hanáček J, Heřman H, Brandejsová A et al. Gravidita v jizvě po císařském řezu – retrospektivní analýza případů z let 2012–2021. Ceska Gynekol 2022; 87 (4): 245–248. doi: 10.48095/ cccg2022245.

33. Long Y, Zhu H, Hu Y et al. Interventions for non-tubal ectopic pregnancy. Cochrane Database Syst Rev 2020; 7 (7): CD011174. Doi: 10.1002/14651858.CD011174.pub2.

34. Hlinecká K, Lisá Z, Richtárová A et al. Intramyometrální gravidita po hysteroskopické resekci reziduí – kazuistika. Ceska Gynekol 2022; 87 (1): 35–39. doi: 10.48095/cccg202235.

35. Nesterová A, Boudová B, Kestřánek J. Intersticiální gravidita. Ceska Gynekol 2022; 87 (6): 408–411. doi: 10.48095/cccg2022408.

36. Horáková K, Horčička L. Dotazníková studie prevalence inkontinence moči v těhotenství a v raném šestinedělí. Ceska Gynekol 2020; 85 (3): 181–186.

37. Švihrová V, Jílková E, Szabóová V et al. Vedomosti respondentov na Slovensku a v Čechách o karcinóme cervixu – projekt Aurora. Ceska Gynekol 2015; 80 (3): 181–188.

38. Zapletal J, Drochýtek V, Vařbuchtová A et al. Analýza informovanosti a akceptace těhotných SARS-CoV-2 vakcinace. Ceska Gynekol 2022; 87 (2): 100–103. doi: 10.48095/cccg2022100.

39. Cerovac A, Habek D. Viable invasive cervical pregnancy treated with minimally invasive procedures. Ceska Gynekol 2023; 88 (5): 380–382. doi: 10.48095/cccg2023380.

40. Hanáček J, Heřman H, Křepelka P et al. Gra- vidita v jizvě po císařském řezu. Ceska Gynekol 2022; 87 (3): 193–197. doi: 10.48095/cccg20 22193.

41. Karásek V. Gravidita v jizvě po císařském řezu – kazuistika. Ceska Gynekol 2015; 80 (5): 382–385.

42. Totka A, Gábor M, Alföldi M et al. Sonograficky riadená vákuumaspiračná liečba ektopickej gravidity v jazve po cisárskom reze. Ceska Gynekol 2021; 86 (3): 184–188. doi: 10.48095/cccg2021184.

43. Zahálková L, Kacerovský M. Ektopická gravidita v jizvě po císařském řezu. Ceska Gynekol 2016; 81 (6): 414–419.

ORCID autorů

B. Švédová 0009-0006-6209-0533

M. Hruda 0000-0002-7606-5164

V. Drochýtek 0000-0002-3391-1412

M. J. Halaška 0000-0001-6055-2569

K. Maxová 0009-0003-3473-4766

N. Janovská 0009-0006-5832-7702

A. Babková 0009-0008-9268-6957

L. Rob 0000-0003-3770-651X

B. Sehnal 0000-0003-2622-2181

Doručeno/Submitted: 22. 11. 2024