Transformations in fertility management: evaluation of the effect of methotrexate in the treatment of ectopic pregnancies
Keywords:
ADMINISTRACIÓN DEL TRATAMIENTO FARMACOLÓGICO; COMPLICACIONES DEL EMBARAZO; EMBARAZO ECTÓPICO; FERTILIDAD; METOTREXATO.; ECTOPIC PREGNANCY, METHOTREXATE, PHARMACOLOGICAL TREATMENT, GYNECOLOGICAL MANAGEMENT, NONINVASIVE ALTERNATIVES.; CONDUTA DO TRATAMENTO MEDICAMENTOSO; COMPLICAÇÕES NA GRAVIDEZ; GRAVIDEZ ECTÓPICA; FERTILIDADE; METOTREXATO.Abstract
Introduction: ectopic pregnancy constitutes a significant complication in reproductive health, characterized by the extrauterine implantation of the embryo and associated with serious risks to maternal life.
Objective: to evaluate the efficacy of methotrexate as a pharmacological alternative in the management of ectopic pregnancy.
Methods: a systematic review of the scientific literature was conducted across multiple databases. The search was performed using an algorithm with keywords and Boolean operators, allowing the identification of relevant sources. Selected studies, after applying inclusion and exclusion criteria, were critically analyzed considering timeliness, methodological quality, and thematic relevance, and subsequently integrated into the final synthesis of the review.
Development: the reviewed literature confirms that methotrexate, a folic acid antagonist, interrupts cellular proliferation of trophoblastic tissue, promoting its reabsorption and preventing tubal rupture. Administration protocols in single, double, and multiple doses were identified, with success rates close to 90 %. Benefits include reduced pain, faster recovery, and lower hospital costs compared to laparoscopic surgery. Nevertheless, emphasis is placed on selecting hemodynamically stable patients without fetal activity, given the risk of hepatic, renal, and hematological toxicity.
Conclusions: Methotrexate is consolidated as a safe and effective therapeutic option for selected ectopic pregnancies, offering advantages over surgery. Its implementation requires strict monitoring and precise clinical criteria, representing a significant contribution to the optimization of contemporary gynecological management.
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