Conservative therapy of interstitial pregnancy in deep infiltrative endometriosis

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This article summarizes data on the prevalence, risk factors and the role of external genital endometriosis in the development of ectopic pregnancy. The existing algorithms for the use of conservative therapy of ectopic pregnancy of rare localizations are discussed. The authors presented a clinical case of using methotrexate in the treatment of a patient with infiltrative endometriosis and trophoblast persistence after laparoscopic removal of interstitial tubal pregnancy.

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About the authors

Armine R. Khachaturyan

The Research Institute of Obstetrics, Gynecology, and Reproductology named after D.O. Ott; Saint Petersburg State University

Author for correspondence.
ORCID iD: 0000-0003-2141-6307
SPIN-code: 2691-3910

Russian Federation, Saint Petersburg

MD, PhD, Senior Researcher. The Department of Gynecology and Endocrinology; Associate Professor. The Department of Obstetrics, Gynecology, and Reproductive Sciences, the Faculty of Medicine

Maria I. Yarmolinskaya

The Research Institute of Obstetrics, Gynecology, and Reproductology named after D.O. Ott; North-Western State Medical University named after I.I. Mechnikov

ORCID iD: 0000-0002-6551-4147
SPIN-code: 3686-3605
Scopus Author ID: 7801562649
ResearcherId: P-2183-2014

Russian Federation, Saint Petersburg

MD, PhD, DSci (Medicine), Professor, Professor of the Russian Academy of Sciences, Head of the Department of Gynecology and Endocrinology, Head of the Diagnostics and Treatment of Endometriosis Center; Professor. The Department of Obstetrics and Gynecology

Anna A. Tsypurdeyeva

The Research Institute of Obstetrics, Gynecology, and Reproductology named after D.O. Ott; Saint Petersburg State University

ORCID iD: 0000-0001-7774-2094
SPIN-code: 5208-9707

Russian Federation, Saint Petersburg

MD, PhD, Head of the Department of Gynecology with the Operating Unit; Associate Professor. The Department of Obstetrics, Gynecology, and Reproductive Sciences, the Faculty of Medicine

Eduard N. Popov


ORCID iD: 0000-0001-8671-3551
ResearcherId: K-2802-2018

Russian Federation, Saint Petersburg

MD, Head of the Department of Operative Gynecology

Alexandra I. Rudikova

The Research Institute of Obstetrics, Gynecology, and Reproductology named after D.O. Ott

ORCID iD: 0000-0002-3505-8240

Russian Federation, Saint Petersburg



  1. Основные показатели деятельности акушерско-гинекологической службы в Российской Федерации в 2018 году. Справочник Министерства здравоохранения Российской Федерации. – М., 2019. [Osnovnye pokazateli deyatel’nosti akushersko-ginekologicheskoy sluzhby v Rossiyskoy Federatsii v 2018 godu. Spravochnik Ministerstva zdravookhraneniya Rossiyskoy Federatsii. Moscow; 2019. (In Russ.)]
  2. Клинические рекомендации (протокол лечения). Внематочная (эктопическая) беременность. – М., 2017. – 35 с. [Klinicheskie rekomendatsii (protokol lecheniya). Vnematochnaya (ektopicheskaya) beremennost’. Moscow; 2017. 35 р. (In Russ.)]
  3. Saraswat L, Ayansina DT, Cooper KG, et al. Pregnancy outcomes in women with endometriosis: A national record linkage study. BJOG. 2017;124(3):444-452.
  4. Ankum WM, Mol BW, van der Veen F, Bossuyt PM. Risk factors for ectopic pregnancy: A meta-analysis. Fertil Steril. 1996;65(6):1093-1099.
  5. Hjordt Hansen MV, Dalsgaard T, Hartwell D, et al. Reproductive prognosis in endometriosis. A national cohort study. Acta Obstet Gynecol Scand. 2014;93(5):483-489.
  6. Hwang A, Chou L, Islam MM, et al. Risk factors for ectopic pregnancy in the Taiwanese population: Aretrospective observational study. Arch Gynecol Obstet. 2016;294(4):779-783.
  7. Beobachtungen der k. k. medizinisch-chirurgischen Josephs-Aсademie zu Wien: Band. Camesina; 1801. 189 р.
  8. Reid P, Buddha LL. Hysteroscopic diagnosis of interstitial ectopic pregnancy. BJOG. 2004;111(1):89-90.
  9. Meyer WR, Mitchell DE. Hysteroscopic removal of an interstitial ectopic gestation. A case report. J Reprod Med. 1989;34(11):928-929.
  10. Tanaka T, Hayashi H, Kutsuzawa T, et al. Treatment of interstitial ectopic pregnancy with methotrexate: Report of a successful case. Fertil Steril. 1982;37(6):851-852.
  11. 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(2):107-111.
  12. Lozeau AM, Potter B. Diagnosis and management of ectopic pregnancy. Am Fam Physician. 2005;72(9):1707−1714. [Erratum in am fam physician. 2007;75(3):312].
  13. Seror V, Gelfucci F, Gerbaud L, et al. Care pathways for ectopic pregnancy: A population-based cost-effectiveness analysis. Fertil Steril. 2007;87(4):737-748. 10.1016/j.fertnstert.2006.11.005.
  14. National Collaborating Centre for Women’s and Children’s Health (UK). Ectopic pregnancy and miscarriage: Diagnosis and initial management in early pregnancy of ectopic pregnancy and miscarriage. London: RCOG; 2012.
  15. Lipscomb GH. Medical management of ectopic pregnancy. Clin Obstet Gynecol. 2012;55(2):424-432. 10.1097/GRF.0b013e3182510a48.
  16. Diagnosis and management of ectopic pregnancy: Green-top guideline No. 21. BJOG. 2016;123(13):e15-e55.
  17. Yao M, Tulandi T. Current status of surgical and nonsurgical management of ectopic pregnancy. Fertil Steril. 1997;67(3):421-433.
  18. Sowter MC, Frappell J. The role of laparoscopy in the management of ectopic pregnancy. Rev Gyn Practice. 2002;2(1-2):73-82. 00007-2.
  19. Hajenius PJ, Mol BW, Ankum WM, et al. Clearance curves of serum human chorionic gonadotrophin for the diagnosis of persistent trophoblast. Hum Reprod. 1995;10(3):683-687.
  20. Lund CO, Nilas L, Bangsgaard N, Ottesen B. Persistent ectopic pregnancy after linear salpingotomy: A non-predictable complication to conservative surgery for tubal gestation. Acta Obstet Gynecol Scand. 2002;81(11):1053-1059.
  21. National Guideline Alliance (UK). Ectopic pregnancy and miscarriage: Diagnosis and initial management. London: National Institute for Health and Care Excellence (UK); 2019.
  22. Kirk E, van Calster B, Condous G, et al. Ectopic pregnancy: using the hCG ratio to select women for expectant or medical management. Acta Obstet Gynecol Scand. 2011;90(3):264-272. 2010.01053.x.
  23. Da Costa Soares R, Elito J Jr, Camano L. Increment in beta-hCG in the 48-h period prior to treatment: A new variable predictive of therapeutic success in the treatment of ectopic pregnancy with methotrexate. Arch Gynecol Obstet. 2008;278(4):319-324.
  24. Nguyen Q, Kapitz M, Downes K, Silva C. Are early human chorionic gonadotropin levels after methotrexate therapy a predictor of response in ectopic pregnancy? Am J Obstet Gynecol. 2010;202(6):630.e1-5. j.ajog.2010.03.022.
  25. Skubisz MM, Li J, Wallace EM, Tong S. Decline in βhCG levels between days 0 and 4 after a single dose of methotrexate for ectopic pregnancy predicts treatment success: A retrospective cohort study. BJOG. 2011;118(13):1665-1668.
  26. Stovall TG, Ling FW, Gray LA. Single-dose methotrexate for treatment of ectopic pregnancy. Obstet Gynecol. 1991;77(5):754-757.
  27. Fernandez H, Bourget P, Ville Y, et al. Treatment of unruptured tubal pregnancy with methotrexate: Pharmacokinetic analysis of local versus intramuscular administration. Fertil Steril. 1994;62(5):943-947.
  28. Marret H, Fauconnier A, Dubernard G, et al. [Evidence-based evaluation and expertise of methotrexate off label use in gynaecology and obstetrics: Work of the CNGOF. (In French)]. J Gynecol Obstet Biol Reprod. 2015;44(3):230-236.
  29. Ярмолинская М.И., Айламазян Э.К. Генитальный эндометриоз. Различные грани проблемы. – СПб.: Эко-Вектор, 2017. – 615 c. [Yarmolinskaya MI, Aylamazyan EK. Genital’ny endometrioz. Razlichnye grani problemy. Saint Petersburg: Eko-Vektor; 2017. 615 p. (In Russ.)]



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Copyright (c) 2020 Khachaturyan A.R., Yarmolinskaya M.I., Tsypurdeyeva A.A., Popov E.N., Rudikova A.I.

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