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| Traitement Medical De La Grossesse Extra-Uterine: à propos de 20 cas et revue de la littérature
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F.OUAKKA, M.B.IDRISSI, M.K.SAOUD, N.MAMOUNI, S.ERRARHAY, C.BOUCHIKHI, A.BANANI
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Abstract:
Introduction: Ectopic pregnancy (EP) is one of the main causes of maternal mortality whose diagnosis has become earlier thanks to the ?-HCG assay and endovaginal ultrasound. The treatment of EP has indeed evolved? in three phases, initially surgical by laparotomy, from the 1980s onwards, laparoscopic management has become the reference treatment. Material and methods: We conducted a retrospective study of 20 cases of ectopic pregnancy treated with methotrexate in the obstetrics gynecology department of the CHU HASSAN II of FES over a period of 09 years. The analysis of the medical files allowed us to characterize the epidemiological and diagnostic aspects of these cases, to evaluate the effectiveness of the treatment by methotrexate and to compare our results with those of the literature as well as to evaluate the prognosis and the obstetrical fate of the patients treated by MTX. Results: EP remains a relatively common condition in our study with a rate of 1.09%. The average age of our MTX-treated patients was 29 years, with a peak of frequency in the age groups between 26 and 35 years, representing 55% of our patients. Our sample is characterised? by low parity?, with 50% nulliparous, 30% primiparous and 20% multiparous. The most frequent risk factors in our series were: oral contraception in 45% of cases, previous miscarriage in 20% of patients and previous abdomino-pelvic surgery such as caesarean section found in 15% of our patients. However, none of our patients had a history of EP. Clinically, the classic functional triad was? found in 60% of cases. The ?-hCG level was < 1000 IU/l in 65% of cases, its mean initial value in our series was 1376 IU/L. All patients received medical treatment with intramuscular parenteral methotrexate, of which 18 benefited? from a single injection, i.e. a rate of 90%, and 2 patients received 2 IM injections in view of the unsatisfactory drop in b-HCG. With an overall success rate of medical treatment estimated at 95%. Only one case of failure was observed in our study, which benefited from a salpingectomy. However, there were no deaths? in our study. Among the 14 patients desiring pregnancy summoned, 9 patients were able to have an intrauterine pregnancy after an average contraceptive duration of 10 months, which represents 47.36% of cases. On the other hand, no case of recurrence of EP was deplored?. Conclusion: Through the review of the literature and our series made of 20 cases, we noted? a success of 95% by MTX administration thus reinforcing the place of the medical treatment in the therapeutic arsenal of the ectopic pregnancy.
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