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Консервативная тактика ведения пациенток с внематочной беременностью
Доброхотова Ю.Э., Белоусова Т.Н., Боровкова Е.И., Соваев Н.И., Егорушкина В.Д., Кладницкая А.Д., Ермакова А. Консервативная тактика ведения пациенток с внематочной беременностью. Гинекология. 2023;25(4):435–441. DOI: 10.26442/20795696.2023.4.202518
© ООО «КОНСИЛИУМ МЕДИКУМ», 2023 г.
© ООО «КОНСИЛИУМ МЕДИКУМ», 2023 г.
________________________________________________
Dobrokhotova YuE, Belousova TN, Borovkova EI, Sovaev NI, Egorushkina VD, Kladnitskaya AD, Ermakova A. Non-surgical management of patients with ectopic pregnancy: A review. Gynecology. 2023;25(4):435–441.
DOI: 10.26442/20795696.2023.4.202518
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Аннотация
Внематочная беременность является состоянием, требующим оказания неотложной медицинской помощи. В настоящее время хирургическое лечение является основным методом терапии, а консервативное лечение с применением метотрексата рассматривается в качестве допустимой альтернативы. Метотрексат является антагонистом фолиевой кислоты и оказывает ингибирующее действие на пролиферацию клеток трофобласта. Существуют различные протоколы применения метотрексата, выбор которых определяется уровнем β-субъединицы хорионического гонадотропина человека, локализацией внематочной беременности и приверженностью пациентки лечению. Терапия внематочной трубной беременности метотрексатом является эффективной и безопасной альтернативой хирургическому лечению, не оказывает влияния на показатели овариального резерва и сохраняет возможность женщины реализовать ее репродуктивную функцию.
Ключевые слова: внематочная трубная беременность, метотрексат, сальпингэктомия, сальпингостомия, Лейковорин, трофобласт, овариальный резерв
Ключевые слова: внематочная трубная беременность, метотрексат, сальпингэктомия, сальпингостомия, Лейковорин, трофобласт, овариальный резерв
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An ectopic pregnancy is a medical emergency. Currently, surgery is the main method of therapy, and non-surgical management with methotrexate is considered an acceptable alternative. Methotrexate is a folic acid antagonist and has an inhibitory effect on the proliferation of trophoblast cells. There are various methotrexate regimens; the choice is based on the level of β-subunit of human chorionic gonadotropin, the location of the ectopic pregnancy and the patient's adherence to treatment. Therapy of ectopic tubal pregnancy with methotrexate is an effective and safe alternative to surgical treatment, does not affect the ovarian reserve and preserves the woman's fertility.
Keywords: ectopic tubal pregnancy, methotrexate, salpingectomy, salpingostomy, leucovorin, trophoblast, ovarian reserve
Полный текст
Список литературы
1. Zane SB, Kieke BA Jr, Kendrick JS, Bruce C. Surveillance in a time of changing health care practices: estimating ectopic pregnancy incidence in the United States. Matern Child Health J. 2002;6:227.
2. Справочник Министерства здравоохранения Российской Федерации. M., 2019; c. 30 [Spravochnik Ministerstva zdravookhraneniia Rossiiskoi Federatsii. Moscow, 2019; p. 30 (in Russian)].
3. Van Den Eeden SK, Shan J, Bruce C, Glasser M. Ectopic pregnancy rate and treatment utilization in a large managed care organization. Obstet Gynecol. 2005;105:1052.
4. Hoover KW, Tao G, Kent CK. Trends in the diagnosis and treatment of ectopic pregnancy in the United States. Obstet Gynecol. 2010;115:495.
5. Stulberg DB, Cain LR, Dahlquist I, Lauderdale DS. Ectopic pregnancy rates and racial disparities in the Medicaid population. 2004–2008. Fertil Steril. 2014;102:1671.
6. Mann LM, Kreisel K, Llata E, et al. Trends in Ectopic Pregnancy Diagnoses in United States Emergency Departments. 2006–2013. Matern Child Health J. 2020;24:213.
7. Stulberg DB, Cain L, Dahlquist IH, Lauderdale DS. Ectopic pregnancy morbidity and mortality in low-income women. 2004–2008. Hum Reprod. 2016;31:666.
8. Creanga AA, Shapiro-Mendoza CK, Bish CL, et al. Trends in ectopic pregnancy mortality in the United States: 1980–2007. Obstet Gynecol. 2011;117:837.
9. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 94: Medical management of ectopic pregnancy. Obstet Gynecol. 2008;111:1479.
10. Practice Committee of American Society for Reproductive Medicine. Medical treatment of ectopic pregnancy: a committee opinion. Fertil Steril. 2013;100:638.
11. 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. 2014;70:261.
12. Menon S, Colins J, Barnhart KT. Establishing a human chorionic gonadotropin cutoff to guide methotrexate treatment of ectopic pregnancy: a systematic review. Fertil Steril. 2007;87:481.
13. Lipscomb GH, McCord ML, Stovall TG, et al. Predictors of success of methotrexate treatment in women with tubal ectopic pregnancies. N Engl J Med. 1999;341:1974.
14. Barnhart KT, Gosman G, Ashby R, Sammel M. The medical management of ectopic pregnancy: a meta-analysis comparing "single dose" and "multidose" regimens. Obstet Gynecol. 2003;101:778.
15. Nazac A, Gervaise A, Bouyer J, et al. Predictors of success in methotrexate treatment of women with unruptured tubal pregnancies. Ultrasound Obstet Gynecol. 2003;21:181.
16. Gamzu R, Almog B, Levin Y, et al. The ultrasonographic appearance of tubal pregnancy in patients treated with methotrexate. Hum Reprod. 2002;17:2585.
17. Vermesh M, Graczykowski JW, Sauer MV. Reevaluation of the role of culdocentesis in the management of ectopic pregnancy. Am J Obstet Gynecol. 1990;162:411.
18. Bixby S, Tello R, Kuligowska E. Presence of a yolk sac on transvaginal sonography is the most reliable predictor of single-dose methotrexate treatment failure in ectopic pregnancy. J Ultrasound Med. 2005;24:591.
19. Potter MB, Lepine LA, Jamieson DJ. Predictors of success with methotrexate treatment of tubal ectopic pregnancy at Grady Memorial Hospital. Am J Obstet Gynecol. 2003;188:1192.
20. Dudley PS, Heard MJ, Sangi-Haghpeykar H, et al. Characterizing ectopic pregnancies that rupture despite treatment with methotrexate. Fertil Steril. 2004;82:137.
21. Takacs P, Rodriguez L. High folic acid levels and failure of single-dose methotrexate treatment in ectopic pregnancy. Int J Gynaecol Obstet. 2005;89:301.
22. Levine Y, Yahav L, Schwarzman P, et al. The correlation between endometrial thickness and the criteria for MTX treatment for ectopic pregnancy. J Obstet Gynaecol. 2021;41:1230.
23. Fang T, Chen M, Yu W, et al. The predictive value of endometrial thickness in 3117 fresh IVF/ICSI cycles for ectopic pregnancy. J Gynecol Obstet Hum Reprod. 2021;50:102072.
24. Hoyos LR, Malik M, Najjar M, et al. Morbid obesity and outcome of ectopic pregnancy following capped single-dose regimen methotrexate. Arch Gynecol Obstet. 2017;295:375.
25. Levin G, Meyer R, Dior U, et al. Outcome of methotrexate treatment for ectopic pregnancies among obese women. J Gynecol Obstet Hum Reprod. 2020;101790.
26. Mol F, Mol BW, Ankum WM, et al. Current evidence on surgery, systemic methotrexate and expectant management in the treatment of tubal ectopic pregnancy: a systematic review and meta-analysis. Hum Reprod Update. 2008;14:309.
27. Morlock RJ, Lafata JE, Eisenstein D. Cost-effectiveness of single-dose methotrexate compared with laparoscopic treatment of ectopic pregnancy. Obstet Gynecol. 2000;95:407.
28. Nieuwkerk PT, Hajenius PJ, Ankum WM, et al. Systemic methotrexate therapy versus laparoscopic salpingostomy in patients with tubal pregnancy. Part I. Impact on patients' health-related quality of life. Fertil Steril. 1998;70:511.
29. Grimes DA. Estimation of pregnancy-related mortality risk by pregnancy outcome, United States, 1991 to 1999. Am J Obstet Gynecol. 2006;194:92.
30. Oriol B, Barrio A, Pacheco A, et al. Systemic methotrexate to treat ectopic pregnancy does not affect ovarian reserve. Fertil Steril. 2008;90:1579.
31. Wiser A, Gilbert A, Nahum R, et al. Effects of treatment of ectopic pregnancy with methotrexate or salpingectomy in the subsequent IVF cycle. Reprod Biomed Online. 2013;26:449.
32. Gay C, Perrin J, Courbiere B, et al. Impact of salpingectomy for ectopic pregnancy on the ovarian response during IVF stimulation. J Gynecol Obstet Hum Reprod. 2019;48:727.
33. Ohannessian A, Loundou A, Courbière B, et al. Ovarian responsiveness in women receiving fertility treatment after methotrexate for ectopic pregnancy: a systematic review and meta-analysis. Hum Reprod. 2014;29:1949.
34. Strauss JF, Williams CJ. The ovarian life cycle. In: Yen and Jaffe's Reproductive Endocrinology: Physiology, Pathophysiology, and Clinical Management, 5th ed., Strauss JF, Barbieri RL (Eds.), Elsevier Saunders, Philadelphia, 2004; p. 213.
35. Svirsky R, Rozovski U, Vaknin Z, et al. The safety of conception occurring shortly after methotrexate treatment of an ectopic pregnancy. Reprod Toxicol. 2009;27:85.
36. Chouinard M, Mayrand MH, Ayoub A, et al. Ectopic pregnancy and outcomes of future intrauterine pregnancy. Fertil Steril. 2019;112:112.
37. Lipscomb GH, Givens VM, Meyer NL, Bran D. Comparison of multidose and single-dose methotrexate protocols for the treatment of ectopic pregnancy. Am J Obstet Gynecol. 2005;192:1844.
38. Hajenius PJ, Mol F, Mol BW, et al. Interventions for tubal ectopic pregnancy. Cochrane Database Syst Rev. 2007;CD000324.
39. Alur-Gupta S, Cooney LG, Senapati S, et al. Two-dose versus single-dose methotrexate for treatment of ectopic pregnancy: a meta-analysis. Am J Obstet Gynecol. 2019;221:95.
40. Jermy K, Thomas J, Doo A, Bourne T. The conservative management of interstitial pregnancy. BJOG. 2004;111:1283.
41. American College of Obstetricians and Gynecologists' Committee on Practice Bulletins – Gynecology. ACOG Practice Bulletin No. 193: Tubal Ectopic Pregnancy. Obstet Gynecol. 2018;131:e91.
42. Stovall TG, Ling FW. Single-dose methotrexate: an expanded clinical trial. Am J Obstet Gynecol. 1993;168:1759.
43. Natale A, Candiani M, Barbieri M, et al. Pre- and post-treatment patterns of human chorionic gonadotropin for early detection of persistence after a single dose of methotrexate for ectopic pregnancy. Eur J Obstet Gynecol Reprod Biol. 2004;117:87.
44. Saraj AJ, Wilcox JG, Najmabadi S, et al. Resolution of hormonal markers of ectopic gestation: a randomized trial comparing single-dose intramuscular methotrexate with salpingostomy. Obstet Gynecol. 1998;92:989.
45. Tang A, Baartz D, Khoo SK. A medical management of interstitial ectopic pregnancy: a 5-year clinical study. Aust N Z J Obstet Gynaecol. 2006;46:107.
46. Xiao C, Shi Q, Cheng Q, Xu J. Non-surgical management of tubal ectopic pregnancy: A systematic review and meta-analysis. Medicine (Baltimore). 2021;100:e27851.
47. Nilsson UW, Johns TG, Wilmann T, et al. Effects of gefitinib, an epidermal growth factor receptor inhibitor, on human placental cell growth. Obstet Gynecol. 2013;122:737.
48. Skubisz MM, Horne AW, Johns TG, et al. Combination gefitinib and methotrexate compared with methotrexate alone to treat ectopic pregnancy. Obstet Gynecol. 2013; 122:745.
49. Korhonen J, Stenman UH, Ylöstalo P. Low-dose oral methotrexate with expectant management of ectopic pregnancy. Obstet Gynecol. 1996;88:775.
50. Webster K, Eadon H, Fishburn S, et al. Ectopic pregnancy and miscarriage: diagnosis and initial management: summary of updated NICE guidance. BMJ. 2019;367:l6283.
51. Ectopic pregnancy and miscarriage: diagnosis and initial management. NICE guideline [NG126]. National Institute for Health Care Excellence. April. 2019. Available at: https://www.nice.org.uk/guidance/ng126/chapter/Recommendations#management-of-miscarriage. Accessed: 03.03.2021.
52. Bachman EA, Barnhart K. Medical management of ectopic pregnancy: a comparison of regimens. Clin Obstet Gynecol. 2012;55:440.
53. van Mello NM, Mol F, Verhoeve HR, et al. Methotrexate or expectant management in women with an ectopic pregnancy or pregnancy of unknown location and low serum hCG concentrations? A randomized comparison. Hum Reprod. 2013;28:60.
54. Jurkovic D, Memtsa M, Sawyer E, et al. Single-dose systemic methotrexate vs expectant management for treatment of tubal ectopic pregnancy: a placebo-controlled randomized trial. Ultrasound Obstet Gynecol. 2017;49:171.
55. van Mello NM, Mol F, Adriaanse AH, et al. The METEX study: methotrexate versus expectant management in women with ectopic pregnancy: a randomised controlled trial. BMC Womens Health. 2008;8:10.
56. Silva PM, Araujo Júnior E, Cecchino GN, et al. Effectiveness of expectant management versus methotrexate in tubal ectopic pregnancy: a double-blind randomized trial. Arch Gynecol Obstet. 2015;291:939.
57. van Mello NM, Mol F, Hajenius PJ, et al. Randomized comparison of health-related quality of life in women with ectopic pregnancy or pregnancy of unknown location treated with systemic methotrexate or expectant management. Eur J Obstet Gynecol Reprod Biol. 2015;192:1.
58. Craig LB, Khan S. Expectant management of ectopic pregnancy. Clin Obstet Gynecol. 2012;55:461.
59. Dooley W, De Braud L, Memtsa M, et al. Physical resolution of tubal ectopic pregnancy on ultrasound imaging following successful expectant management. Reprod Biomed Online. 2020;40:880.
60. Strobelt N, Mariani E, Ferrari L, et al. Fertility after ectopic pregnancy. Effects of surgery and expectant management. J Reprod Med. 2000;45:803.
61. Helmy S, Sawyer E, Ofili-Yebovi D, et al. Fertility outcomes following expectant management of tubal ectopic pregnancy. Ultrasound Obstet Gynecol. 2007;30:988.
2. Справочник Министерства здравоохранения Российской Федерации. M., 2019; c. 30 [Spravochnik Ministerstva zdravookhraneniia Rossiiskoi Federatsii. Moscow, 2019; p. 30 (in Russian)].
3. Van Den Eeden SK, Shan J, Bruce C, Glasser M. Ectopic pregnancy rate and treatment utilization in a large managed care organization. Obstet Gynecol. 2005;105:1052.
4. Hoover KW, Tao G, Kent CK. Trends in the diagnosis and treatment of ectopic pregnancy in the United States. Obstet Gynecol. 2010;115:495.
5. Stulberg DB, Cain LR, Dahlquist I, Lauderdale DS. Ectopic pregnancy rates and racial disparities in the Medicaid population. 2004–2008. Fertil Steril. 2014;102:1671.
6. Mann LM, Kreisel K, Llata E, et al. Trends in Ectopic Pregnancy Diagnoses in United States Emergency Departments. 2006–2013. Matern Child Health J. 2020;24:213.
7. Stulberg DB, Cain L, Dahlquist IH, Lauderdale DS. Ectopic pregnancy morbidity and mortality in low-income women. 2004–2008. Hum Reprod. 2016;31:666.
8. Creanga AA, Shapiro-Mendoza CK, Bish CL, et al. Trends in ectopic pregnancy mortality in the United States: 1980–2007. Obstet Gynecol. 2011;117:837.
9. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 94: Medical management of ectopic pregnancy. Obstet Gynecol. 2008;111:1479.
10. Practice Committee of American Society for Reproductive Medicine. Medical treatment of ectopic pregnancy: a committee opinion. Fertil Steril. 2013;100:638.
11. 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. 2014;70:261.
12. Menon S, Colins J, Barnhart KT. Establishing a human chorionic gonadotropin cutoff to guide methotrexate treatment of ectopic pregnancy: a systematic review. Fertil Steril. 2007;87:481.
13. Lipscomb GH, McCord ML, Stovall TG, et al. Predictors of success of methotrexate treatment in women with tubal ectopic pregnancies. N Engl J Med. 1999;341:1974.
14. Barnhart KT, Gosman G, Ashby R, Sammel M. The medical management of ectopic pregnancy: a meta-analysis comparing "single dose" and "multidose" regimens. Obstet Gynecol. 2003;101:778.
15. Nazac A, Gervaise A, Bouyer J, et al. Predictors of success in methotrexate treatment of women with unruptured tubal pregnancies. Ultrasound Obstet Gynecol. 2003;21:181.
16. Gamzu R, Almog B, Levin Y, et al. The ultrasonographic appearance of tubal pregnancy in patients treated with methotrexate. Hum Reprod. 2002;17:2585.
17. Vermesh M, Graczykowski JW, Sauer MV. Reevaluation of the role of culdocentesis in the management of ectopic pregnancy. Am J Obstet Gynecol. 1990;162:411.
18. Bixby S, Tello R, Kuligowska E. Presence of a yolk sac on transvaginal sonography is the most reliable predictor of single-dose methotrexate treatment failure in ectopic pregnancy. J Ultrasound Med. 2005;24:591.
19. Potter MB, Lepine LA, Jamieson DJ. Predictors of success with methotrexate treatment of tubal ectopic pregnancy at Grady Memorial Hospital. Am J Obstet Gynecol. 2003;188:1192.
20. Dudley PS, Heard MJ, Sangi-Haghpeykar H, et al. Characterizing ectopic pregnancies that rupture despite treatment with methotrexate. Fertil Steril. 2004;82:137.
21. Takacs P, Rodriguez L. High folic acid levels and failure of single-dose methotrexate treatment in ectopic pregnancy. Int J Gynaecol Obstet. 2005;89:301.
22. Levine Y, Yahav L, Schwarzman P, et al. The correlation between endometrial thickness and the criteria for MTX treatment for ectopic pregnancy. J Obstet Gynaecol. 2021;41:1230.
23. Fang T, Chen M, Yu W, et al. The predictive value of endometrial thickness in 3117 fresh IVF/ICSI cycles for ectopic pregnancy. J Gynecol Obstet Hum Reprod. 2021;50:102072.
24. Hoyos LR, Malik M, Najjar M, et al. Morbid obesity and outcome of ectopic pregnancy following capped single-dose regimen methotrexate. Arch Gynecol Obstet. 2017;295:375.
25. Levin G, Meyer R, Dior U, et al. Outcome of methotrexate treatment for ectopic pregnancies among obese women. J Gynecol Obstet Hum Reprod. 2020;101790.
26. Mol F, Mol BW, Ankum WM, et al. Current evidence on surgery, systemic methotrexate and expectant management in the treatment of tubal ectopic pregnancy: a systematic review and meta-analysis. Hum Reprod Update. 2008;14:309.
27. Morlock RJ, Lafata JE, Eisenstein D. Cost-effectiveness of single-dose methotrexate compared with laparoscopic treatment of ectopic pregnancy. Obstet Gynecol. 2000;95:407.
28. Nieuwkerk PT, Hajenius PJ, Ankum WM, et al. Systemic methotrexate therapy versus laparoscopic salpingostomy in patients with tubal pregnancy. Part I. Impact on patients' health-related quality of life. Fertil Steril. 1998;70:511.
29. Grimes DA. Estimation of pregnancy-related mortality risk by pregnancy outcome, United States, 1991 to 1999. Am J Obstet Gynecol. 2006;194:92.
30. Oriol B, Barrio A, Pacheco A, et al. Systemic methotrexate to treat ectopic pregnancy does not affect ovarian reserve. Fertil Steril. 2008;90:1579.
31. Wiser A, Gilbert A, Nahum R, et al. Effects of treatment of ectopic pregnancy with methotrexate or salpingectomy in the subsequent IVF cycle. Reprod Biomed Online. 2013;26:449.
32. Gay C, Perrin J, Courbiere B, et al. Impact of salpingectomy for ectopic pregnancy on the ovarian response during IVF stimulation. J Gynecol Obstet Hum Reprod. 2019;48:727.
33. Ohannessian A, Loundou A, Courbière B, et al. Ovarian responsiveness in women receiving fertility treatment after methotrexate for ectopic pregnancy: a systematic review and meta-analysis. Hum Reprod. 2014;29:1949.
34. Strauss JF, Williams CJ. The ovarian life cycle. In: Yen and Jaffe's Reproductive Endocrinology: Physiology, Pathophysiology, and Clinical Management, 5th ed., Strauss JF, Barbieri RL (Eds.), Elsevier Saunders, Philadelphia, 2004; p. 213.
35. Svirsky R, Rozovski U, Vaknin Z, et al. The safety of conception occurring shortly after methotrexate treatment of an ectopic pregnancy. Reprod Toxicol. 2009;27:85.
36. Chouinard M, Mayrand MH, Ayoub A, et al. Ectopic pregnancy and outcomes of future intrauterine pregnancy. Fertil Steril. 2019;112:112.
37. Lipscomb GH, Givens VM, Meyer NL, Bran D. Comparison of multidose and single-dose methotrexate protocols for the treatment of ectopic pregnancy. Am J Obstet Gynecol. 2005;192:1844.
38. Hajenius PJ, Mol F, Mol BW, et al. Interventions for tubal ectopic pregnancy. Cochrane Database Syst Rev. 2007;CD000324.
39. Alur-Gupta S, Cooney LG, Senapati S, et al. Two-dose versus single-dose methotrexate for treatment of ectopic pregnancy: a meta-analysis. Am J Obstet Gynecol. 2019;221:95.
40. Jermy K, Thomas J, Doo A, Bourne T. The conservative management of interstitial pregnancy. BJOG. 2004;111:1283.
41. American College of Obstetricians and Gynecologists' Committee on Practice Bulletins – Gynecology. ACOG Practice Bulletin No. 193: Tubal Ectopic Pregnancy. Obstet Gynecol. 2018;131:e91.
42. Stovall TG, Ling FW. Single-dose methotrexate: an expanded clinical trial. Am J Obstet Gynecol. 1993;168:1759.
43. Natale A, Candiani M, Barbieri M, et al. Pre- and post-treatment patterns of human chorionic gonadotropin for early detection of persistence after a single dose of methotrexate for ectopic pregnancy. Eur J Obstet Gynecol Reprod Biol. 2004;117:87.
44. Saraj AJ, Wilcox JG, Najmabadi S, et al. Resolution of hormonal markers of ectopic gestation: a randomized trial comparing single-dose intramuscular methotrexate with salpingostomy. Obstet Gynecol. 1998;92:989.
45. Tang A, Baartz D, Khoo SK. A medical management of interstitial ectopic pregnancy: a 5-year clinical study. Aust N Z J Obstet Gynaecol. 2006;46:107.
46. Xiao C, Shi Q, Cheng Q, Xu J. Non-surgical management of tubal ectopic pregnancy: A systematic review and meta-analysis. Medicine (Baltimore). 2021;100:e27851.
47. Nilsson UW, Johns TG, Wilmann T, et al. Effects of gefitinib, an epidermal growth factor receptor inhibitor, on human placental cell growth. Obstet Gynecol. 2013;122:737.
48. Skubisz MM, Horne AW, Johns TG, et al. Combination gefitinib and methotrexate compared with methotrexate alone to treat ectopic pregnancy. Obstet Gynecol. 2013; 122:745.
49. Korhonen J, Stenman UH, Ylöstalo P. Low-dose oral methotrexate with expectant management of ectopic pregnancy. Obstet Gynecol. 1996;88:775.
50. Webster K, Eadon H, Fishburn S, et al. Ectopic pregnancy and miscarriage: diagnosis and initial management: summary of updated NICE guidance. BMJ. 2019;367:l6283.
51. Ectopic pregnancy and miscarriage: diagnosis and initial management. NICE guideline [NG126]. National Institute for Health Care Excellence. April. 2019. Available at: https://www.nice.org.uk/guidance/ng126/chapter/Recommendations#management-of-miscarriage. Accessed: 03.03.2021.
52. Bachman EA, Barnhart K. Medical management of ectopic pregnancy: a comparison of regimens. Clin Obstet Gynecol. 2012;55:440.
53. van Mello NM, Mol F, Verhoeve HR, et al. Methotrexate or expectant management in women with an ectopic pregnancy or pregnancy of unknown location and low serum hCG concentrations? A randomized comparison. Hum Reprod. 2013;28:60.
54. Jurkovic D, Memtsa M, Sawyer E, et al. Single-dose systemic methotrexate vs expectant management for treatment of tubal ectopic pregnancy: a placebo-controlled randomized trial. Ultrasound Obstet Gynecol. 2017;49:171.
55. van Mello NM, Mol F, Adriaanse AH, et al. The METEX study: methotrexate versus expectant management in women with ectopic pregnancy: a randomised controlled trial. BMC Womens Health. 2008;8:10.
56. Silva PM, Araujo Júnior E, Cecchino GN, et al. Effectiveness of expectant management versus methotrexate in tubal ectopic pregnancy: a double-blind randomized trial. Arch Gynecol Obstet. 2015;291:939.
57. van Mello NM, Mol F, Hajenius PJ, et al. Randomized comparison of health-related quality of life in women with ectopic pregnancy or pregnancy of unknown location treated with systemic methotrexate or expectant management. Eur J Obstet Gynecol Reprod Biol. 2015;192:1.
58. Craig LB, Khan S. Expectant management of ectopic pregnancy. Clin Obstet Gynecol. 2012;55:461.
59. Dooley W, De Braud L, Memtsa M, et al. Physical resolution of tubal ectopic pregnancy on ultrasound imaging following successful expectant management. Reprod Biomed Online. 2020;40:880.
60. Strobelt N, Mariani E, Ferrari L, et al. Fertility after ectopic pregnancy. Effects of surgery and expectant management. J Reprod Med. 2000;45:803.
61. Helmy S, Sawyer E, Ofili-Yebovi D, et al. Fertility outcomes following expectant management of tubal ectopic pregnancy. Ultrasound Obstet Gynecol. 2007;30:988.
________________________________________________
1. Zane SB, Kieke BA Jr, Kendrick JS, Bruce C. Surveillance in a time of changing health care practices: estimating ectopic pregnancy incidence in the United States. Matern Child Health J. 2002;6:227.
2. Spravochnik Ministerstva zdravookhraneniia Rossiiskoi Federatsii. Moscow, 2019; p. 30 (in Russian).
3. Van Den Eeden SK, Shan J, Bruce C, Glasser M. Ectopic pregnancy rate and treatment utilization in a large managed care organization. Obstet Gynecol. 2005;105:1052.
4. Hoover KW, Tao G, Kent CK. Trends in the diagnosis and treatment of ectopic pregnancy in the United States. Obstet Gynecol. 2010;115:495.
5. Stulberg DB, Cain LR, Dahlquist I, Lauderdale DS. Ectopic pregnancy rates and racial disparities in the Medicaid population. 2004–2008. Fertil Steril. 2014;102:1671.
6. Mann LM, Kreisel K, Llata E, et al. Trends in Ectopic Pregnancy Diagnoses in United States Emergency Departments. 2006–2013. Matern Child Health J. 2020;24:213.
7. Stulberg DB, Cain L, Dahlquist IH, Lauderdale DS. Ectopic pregnancy morbidity and mortality in low-income women. 2004–2008. Hum Reprod. 2016;31:666.
8. Creanga AA, Shapiro-Mendoza CK, Bish CL, et al. Trends in ectopic pregnancy mortality in the United States: 1980–2007. Obstet Gynecol. 2011;117:837.
9. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 94: Medical management of ectopic pregnancy. Obstet Gynecol. 2008;111:1479.
10. Practice Committee of American Society for Reproductive Medicine. Medical treatment of ectopic pregnancy: a committee opinion. Fertil Steril. 2013;100:638.
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Авторы
Ю.Э. Доброхотова1, Т.Н. Белоусова2, Е.И. Боровкова*1, Н.И. Соваев2, В.Д. Егорушкина2, А.Д. Кладницкая1, А. Ермакова1
1ФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава России, Москва, Россия;
2ГБУЗ МО «Видновский перинатальный центр», Видное, Россия
*Katyanikitina@mail.ru
1ФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава России, Москва, Россия;
2ГБУЗ МО «Видновский перинатальный центр», Видное, Россия
*Katyanikitina@mail.ru
________________________________________________
Yulia E. Dobrokhotova1, Tamara N. Belousova2, Ekaterina I. Borovkova*1, Nikolai I. Sovaev2, Vera D. Egorushkina2, Anastasia D. Kladnitskaya1, Anna Ermakova1
1Pirogov Russian National Research Medical University, Moscow, Russia;
2Vidnovsky Perinatal Center, Vidnoe, Russia
*Katyanikitina@mail.ru
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