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DOI: 10.1055/s-0041-1725937
Management of Ectopic Pregnancy and the COVID-19 Pandemic
Dear Editor,
We would like to share ideas on the publication “Medical Treatment for Ectopic Pregnancy during the COVID-19 Pandemic.” Elito Júnior and Araujo Júnior[1] mentioned that the “clinical treatment of ectopic pregnancy by MTX or expectant management is an alternative during the COVID-19 pandemic. An early diagnosis and appropriate selection of treatment options are critical for the success of the treatment.”[1] In fact, using methotrexate (MTX) as alternative treatment for ectopic pregnancy during COVID-19 is a useful approach, and can reduce risk as well as decrease the workload at the hospital. The patient selection is very important. However, it should be noted that MTX might cause renal impairment,[2] and COVID-19 has a trend to develop renal impairment due to the immunopathological process of infection.[3] Close monitoring of the renal function is needed in MTX therapy, and the adjustment of the dosage based on renal function is important.[4]
Author's response
Reply to “Management of Ectopic Pregnancy and the COVID-19 Pandemic”
Júlio Elito Júnior,1 0000-0003-1514-5504 Edward Araújo Júnior1 0000-0002-6145-2532
1Department of Obstetrics, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
Address for correspondence: Edward Araújo Júnior, Departmento de Obstetrícia, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Botucatu 740, Vila Clementino, São Paulo, SP, 04023-062, Brazil (e-mail: araujojred@terra.com.br).
Dear Editor,
Thank you for your comments. The most important message of this letter was the correct selection of patients for the medical treatment with methotrexate (MTX). We mentioned in the third paragraph that one of the exclusion criteria was renal dysfunction. Therefore, before the treatment, blood samples of every patient were collected for some exams, and one of them was creatinine. High levels of creatine were an exclusion criterion for the MTX treatment. On the other hand, patients with normal levels of creatinine can be submitted to the medical treatment. For tubal pregnancies, we recommend a single dose of MTX (50 mg/m2). The risk of renal impairment related to this dose is very rare.[1] However, close monitoring of the renal function is necessary in cases of non-tubal pregnancies submitted to the protocol of multiple doses of MTX.
Conflict of Interests
The authors have no conflict of interests to declare.
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Conflict of Interests
The authors have no conflict of interests to declare.
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References
- 1 Elito Júnior J, Araujo Júnior E. Medical treatment for ectopic pregnancy during the COVID-19 pandemic. Rev Bras Ginecol Obstet 2020; 42 (12) 849-850 DOI: 10.1055/s-0040-1718438.
- 2 Howard SC, McCormick J, Pui CH, Buddington RK, Harvey RD. Preventing and managing toxicities of high-dose methotrexate. Oncologist 2016; 21 (12) 1471-1482 DOI: 10.1634/theoncologist.2015-0164.
- 3 Sriwijitalai W, Wiwanitkit V. Coronavirus-antibody immune complex: A nanostructure appraisal possible cause of nephropathology. Saudi J Kidney Dis Transpl 2020; 31 (03) 694-695 DOI: 10.4103/1319-2442.289457.
- 4 Nunes LLA, Lima TM. Use of medicines for covid-19 treatment in patients with loss of kidney function: a narrative review. J Bras Nefrol 2020; •••: S0101-28002020005044202 DOI: 10.1590/2175-8239-JBN-2020-0105. [ahead of print]
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Reference
- 1 Clark LE, Bhagavath B, Wheeler CA, Frishman GN, Carson SA. Role of routine monitoring of liver and renal function during treatment of ectopic pregnancies with single-dose methotrexate protocol. Fertil Steril 2012; 98 (01) 84-88 DOI: 10.1016/j.fertnstert.2012.03.037.
Address for correspondence
Publication History
Article published online:
26 February 2021
© 2021. Federação Brasileira de Ginecologia e Obstetrícia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)
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References
- 1 Elito Júnior J, Araujo Júnior E. Medical treatment for ectopic pregnancy during the COVID-19 pandemic. Rev Bras Ginecol Obstet 2020; 42 (12) 849-850 DOI: 10.1055/s-0040-1718438.
- 2 Howard SC, McCormick J, Pui CH, Buddington RK, Harvey RD. Preventing and managing toxicities of high-dose methotrexate. Oncologist 2016; 21 (12) 1471-1482 DOI: 10.1634/theoncologist.2015-0164.
- 3 Sriwijitalai W, Wiwanitkit V. Coronavirus-antibody immune complex: A nanostructure appraisal possible cause of nephropathology. Saudi J Kidney Dis Transpl 2020; 31 (03) 694-695 DOI: 10.4103/1319-2442.289457.
- 4 Nunes LLA, Lima TM. Use of medicines for covid-19 treatment in patients with loss of kidney function: a narrative review. J Bras Nefrol 2020; •••: S0101-28002020005044202 DOI: 10.1590/2175-8239-JBN-2020-0105. [ahead of print]
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Reference
- 1 Clark LE, Bhagavath B, Wheeler CA, Frishman GN, Carson SA. Role of routine monitoring of liver and renal function during treatment of ectopic pregnancies with single-dose methotrexate protocol. Fertil Steril 2012; 98 (01) 84-88 DOI: 10.1016/j.fertnstert.2012.03.037.