Seguridad y eficacia del tratamiento farmacológico con metotrexate en embarazo ectópico no accidentado
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2019
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Escuela de Graduados
Resumen
Antecedentes: En Ecuador de acuerdo a estadísticas obtenidas del Instituto
ecuatoriano de estadística y censos (INEC) en 2014 el Embarazo ectópico ocupo
el 4to lugar dentro de las diez primeras causas de muerte a nivel nacional. En el
hospital Dr. Teodoro Maldonado Carbo” entre 2015 al 2018 los diagnósticos
existieron 289 casos de esta patología. Por este motivo es necesario buscar un
tratamiento preventivo, adecuado e individualizado para cada paciente, siempre
pensando en su fertilidad futura, acoplándose a las guías internacionales con el
uso sistémico de Metotrexate.
Objetivo: Determinar la seguridad y eficacia del tratamiento farmacológico con
metotrexate en embarazo ectópico no accidentado.
Metodología: Se realizo un estudio de enfoque cuantitativo de tipo observacional
analítico, no experimental, ya que se buscó establecer si existen diferencias en el
resultado y si este fue atribuible al tipo de manejo. La investigación tuvo una
indagación prospectiva de tipo cohorte.
Resultados: De manera no probabilística se eligieron 130 casos consecutivos que
se distribuyeron de la siguiente forma: 32 pacientes tratados con MTX y 98
pacientes manejados mediante cirugía a cielo abierto. El éxito del tratamiento fue
alto en ambos grupos (94,7% vs 100%), pero un poco mayor entre los pacientes
sometidos a cirugía, lo que representó diferencia estadística (P < 0.05). En cuanto
a la presencia de hemorragia, aunque existió una tendencia a existir un aumento
de los casos de metrorragia entre los pacientes que presentaron cirugía a cielo
abierto (53,3% vs 36.8%), no se pudo observar diferencia estadística (P > 0.05).
En lo referente a dolor pélvico, mientras que su presencia fue referida en todos los
casos que tuvieron tratamiento quirúrgico, se informó en menos de la mitad de los
pacientes que fueron indicados con metrotexato (100% vs 47,4%), lo que fue
estadísticamente significativo (P < 0,001). La presencia de náuseas y vómitos fue
informada solo entre los pacientes indicados para cirugía (8,7% vs 0%) pero esto
no constituyó diferencia estadística (P > 0.05). En relación a la localización, en los
VI
dos grupos de estudios, la más frecuente fue la ampular (94,7% vs 98,9%), La
presencia de factores de riesgo de embarazo ectópico, en general se informó en el
39,5% de pacientes indicado para tratamiento con metrotexato y en un 41% de
pacientes entre los que se realizó cirugía, lo que no constituyó diferencia
estadística (P > 0.05).
Conclusiones: El uso del tratamiento farmacológico con metrotexato es más
seguro y efectivo que el uso de la cirugía a cielo abierto.
Background: An ectopic pregnancy is defined as a pregnancy outside the uterine cavity, finding 84% in the fallopian tubes. It has been described in lesser percentage in the cervix, intramural, ovarian and abdominal. Several surgical techniques have been described as a treatment, however in a few selected cases we can avoid surgery and use a conservative pharmacological approach. Methotrexate is an antimetabolite of the antifolate type. It inhibits folic acid, it is also essential for purine and pyrimidine base biosynthesis, so synthesis, therefore inhibits the synthesis of DNA, RNA and proteins. In the “Dr. Teodoro Maldonado Carbo” - Hospital, between 2015 and 2018 the diagnoses of preeclampsia were found in 289 cases. For this reason, it is necessary to predict their appearance, find a medical treatment that is suitable, individualized for each patient, always thinking in their fertility, founding the treatment to the already existing international guidelines for the systemic use of Metotrexate. Objective: To determine the efficacy and safety of the use of pharmacological treatment of methotrexate in patients with the diagnosis of ectopic un rupture pregnancy. Methodology: A retrospective study was developed with quantitate focus, observational, descriptive with no experimental analysis. We include 130 patients (32 with the use of MTX, 98 surgery) between entre January 2015 to July of 2018 of Teodoro Maldonado Carbo hospital. Results: We include in our study 130 patients then randomly assigned 32 patients treated with MTX and 98 patients with surgery, the treatment was succesfull in both groups (94,7% vs 100%), but i little bit higher in the patients undergoin the surgycal treatment (P < 0.05). The presence of bleeding was higher in the surgycal group (53,3% vs 36.8%) (P > 0.05). Pelvic pain was present in all of the patients of the surgycal group, and were present in less than half in the medical treatment group (100% vs 47,4%) (P < 0,001). In both groups, the most frecuent location was the ampular segment (94,7% vs 98,9%). The presence of risk factors in general was 39,5% in the metrotexate group and 41% among the surgery group (P > 0.05). Conclusions: The pharmacological treatment of unrupture ectopic pregnancy is VIII safe and efficient with the systemic use of methotrexate compared to the use of surgery.
Background: An ectopic pregnancy is defined as a pregnancy outside the uterine cavity, finding 84% in the fallopian tubes. It has been described in lesser percentage in the cervix, intramural, ovarian and abdominal. Several surgical techniques have been described as a treatment, however in a few selected cases we can avoid surgery and use a conservative pharmacological approach. Methotrexate is an antimetabolite of the antifolate type. It inhibits folic acid, it is also essential for purine and pyrimidine base biosynthesis, so synthesis, therefore inhibits the synthesis of DNA, RNA and proteins. In the “Dr. Teodoro Maldonado Carbo” - Hospital, between 2015 and 2018 the diagnoses of preeclampsia were found in 289 cases. For this reason, it is necessary to predict their appearance, find a medical treatment that is suitable, individualized for each patient, always thinking in their fertility, founding the treatment to the already existing international guidelines for the systemic use of Metotrexate. Objective: To determine the efficacy and safety of the use of pharmacological treatment of methotrexate in patients with the diagnosis of ectopic un rupture pregnancy. Methodology: A retrospective study was developed with quantitate focus, observational, descriptive with no experimental analysis. We include 130 patients (32 with the use of MTX, 98 surgery) between entre January 2015 to July of 2018 of Teodoro Maldonado Carbo hospital. Results: We include in our study 130 patients then randomly assigned 32 patients treated with MTX and 98 patients with surgery, the treatment was succesfull in both groups (94,7% vs 100%), but i little bit higher in the patients undergoin the surgycal treatment (P < 0.05). The presence of bleeding was higher in the surgycal group (53,3% vs 36.8%) (P > 0.05). Pelvic pain was present in all of the patients of the surgycal group, and were present in less than half in the medical treatment group (100% vs 47,4%) (P < 0,001). In both groups, the most frecuent location was the ampular segment (94,7% vs 98,9%). The presence of risk factors in general was 39,5% in the metrotexate group and 41% among the surgery group (P > 0.05). Conclusions: The pharmacological treatment of unrupture ectopic pregnancy is VIII safe and efficient with the systemic use of methotrexate compared to the use of surgery.
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Embarazo ectópico, Resultado del tratamiento, Metotrexato, Factores de riesgo, Hospital de Especialidades Dr. Teodoro Maldonado Carbo, Cantón Guayaquil, Ecuador