title: [Evidence-based evaluation and expertise of methotrexate off label use in gynaecology and obstetrics: work of the CNGOF].
abstract: In the absence of contraindication, methotrexate by intramuscular unique injection of 1mg/kg or 50mg/m(2) is the medical treatment recommended for tubal ectopic pregnancy (EP; LE1). It can be renewed once, at the same dose, according to hCG rates decrease. The pretherapeutic biological assessment contains blood cells numeration, renal and hepatic function. Methotrexate therapy constitutes an alternative conservative treatment to laparoscopic salpingotomy for non-complicated tubal EP (LE1) with hCG level <5000 UI/L (LE2). When the rates of hCG are <1000 UI and or presented a spontaneous decreasing kinetics, the simple prospect (LE2) is preferred. It is recommended to use intramuscular methotrexate in case of surgical conservative treatment failure or more prematurely if the follow-up is not possible (LE3). Except in particular cases there is no indication to use methotrexate in local injection under sonographic control in usual tubal EP (LE2). The use of in situ injection methotrexate is an option to handle the cervical, interstitial or on caesareans scar pregnancies (LE2). In front of a persistent undetermined location pregnancy, after more than 10 days of survey, in an asymptomatic woman and/or at rate of hCG >2000 UI/L, the systematic treatment by methotrexate is an option. The methotrexate is not indicated for first trimester termination of pregnancy or miscarriage neither in placentas accreta nor in association with other treatments such myfegine or potassium.
authors: Service de gynécologie, hôpital Bretonneau, CHU de Tours, faculté de médecine de Tours, François-Rabelais, 2, boulevard Tonnellé, 37044 Tours cedex 1, France; UMR Inserm U930, université François-Rabelais, 2, boulevard Tonnellé, 37044 Tours cedex 9, France; CNGOF, 91, boulevard de Sébastopol, 75002 Paris, France. Electronic address: marret@med.univ-tours.fr.
authors: H
authors: H
authors: Marret
authors: EA 7285, unité de recherche, université Versailles - Saint-Quentin, 2, avenue de la Source-de-la-Bièvre, 78180 Montigny-le-Bretonneux, France; Service de gynécologie-obstétrique, CHI Poissy-Saint-Germain-en-Laye, 10, rue du Champ-Gaillard, BP 3082, 78303 Poissy cedex, France; CNGOF, 91, boulevard de Sébastopol, 75002 Paris, France.
authors: A
authors: A
authors: Fauconnier
authors: Service de gynécologie-obstétrique, hôpital de la Croix-Rousse, hospices civils de Lyon, université Claude-Bernard - Lyon 1, 103, Grande-Rue de la Croix-Rousse, 69317 Lyon cedex, France; CNGOF, 91, boulevard de Sébastopol, 75002 Paris, France.
authors: G
authors: G
authors: Dubernard
authors: Service de gynécologie-obstétrique, hôpital de la Croix-Rousse, hospices civils de Lyon, université Claude-Bernard - Lyon 1, 103, Grande-Rue de la Croix-Rousse, 69317 Lyon cedex, France; CNGOF, 91, boulevard de Sébastopol, 75002 Paris, France.
authors: H
authors: H
authors: Misme
authors: Centre régional de pharmacovigilance, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex 9, France; CNGOF, 91, boulevard de Sébastopol, 75002 Paris, France.
authors: L
authors: L
authors: Lagarce
authors: Service de gynécologie-obstétrique, CHU du Kremlin-Bicêtre, 78, avenue du Général-Leclerc, 94276 Le Kremlin-Bicêtre, France; CNGOF, 91, boulevard de Sébastopol, 75002 Paris, France.
authors: M
authors: M
authors: Lesavre
authors: Service de gynécologie-obstétrique, CHU du Kremlin-Bicêtre, 78, avenue du Général-Leclerc, 94276 Le Kremlin-Bicêtre, France; CNGOF, 91, boulevard de Sébastopol, 75002 Paris, France.
authors: H
authors: H
authors: Fernandez
authors: EA 7285, unité de recherche, université Versailles - Saint-Quentin, 2, avenue de la Source-de-la-Bièvre, 78180 Montigny-le-Bretonneux, France; Service de gynécologie-obstétrique, CHI Poissy-Saint-Germain-en-Laye, 10, rue du Champ-Gaillard, BP 3082, 78303 Poissy cedex, France; CNGOF, 91, boulevard de Sébastopol, 75002 Paris, France.
authors: C
authors: C
authors: Mimoun
authors: Pôle de gynécologie-obstétrique, hôpital de la Conception, CHU de Marseille, 147, boulevard Baille, 13005 Marseille, France; CNGOF, 91, boulevard de Sébastopol, 75002 Paris, France.
authors: C
authors: C
authors: Tourette
authors: Service de gynécologie-obstétrique et de médecine de le reproduction, CHU Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand cedex, France; CNGOF, 91, boulevard de Sébastopol, 75002 Paris, France.
authors: S
authors: S
authors: Curinier
authors: Service de gynécologie-obstétrique et de médecine de le reproduction, CHU Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand cedex, France; CNGOF, 91, boulevard de Sébastopol, 75002 Paris, France.
authors: B
authors: B
authors: Rabishong
authors: Pôle de gynécologie-obstétrique, hôpital de la Conception, CHU de Marseille, 147, boulevard Baille, 13005 Marseille, France; CNGOF, 91, boulevard de Sébastopol, 75002 Paris, France.
authors: A
authors: A
authors: Agostini
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage*; D019317:Evidence-Based Medicine / Q000592:standards*; D005260:Female; D006176:Gynecology / Q000592:standards*; D006801:Humans; D008727:Methotrexate / Q000008:administration & dosage*; D009774:Obstetrics / Q000592:standards*; D056687:Off-Label Use / Q000592:standards*; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000188:drug therapy*
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D008727:Methotrexate
keywords: Cervical pregnancy; Ectopic pregnancy; Grossesse cervicale; Grossesse extra utérine; Grossesse interstitielle; Guideline; HCG; Interstitial pregnancy; Methotrexate; Recommandation