Treatment of unruptured tubal pregnancy by local injection of methotrexate under transvaginal sonographic control.
Seventeen unruptured tubal gestations were managed on an outpatient basis using local methotrexate (MTX) injection. A single 50-mg dose of MTX was injected into the gestational sac under transvaginal sonographic control. Follow-up included serial assays of the beta-subunit of human chorionic gonadotropin (beta-hCG), clinical and sonographic evaluation. Resolution was obtained in 13 out of 17 patients. The regression curve between days after treatment versus beta-hCG (y = 82.2 - 10.8x + 0.37x2) demonstrated a significant negative correlation (R2 = 0.77; R = 0.88; P less than or equal to 0.02). The mean beta-hCG level on day 15 was 3.2% +/- 3.1% of the initial value. Laparoscopy was performed in 4 patients. Pathological findings suggested that resolution was underway in these four cases despite a slow decline in beta-hCG. No systemic side effects were observed in any of the 17 patients. Long-term follow-up is needed to evaluate tubal patency and reproductive outcome. Our experience suggests that local injection of MTX may be an effective alternative for the treatment of unruptured ectopic pregnancy.
Department of Gynecology and Obstetrics, University of Paris VII, Xavier-Bichat School of Medicine, France.
A
A
Ménard
J
J
Créquat
L
L
Mandelbrot
J P
JP
Hauuy
P
P
Madelenat
D006063:Chorionic Gonadotropin / Q000097:blood; D018997:Chorionic Gonadotropin, beta Subunit, Human; D002824:Chorionic Villi / Q000473:pathology; D005260:Female; D006801:Humans; D008727:Methotrexate / Q000008:administration & dosage / Q000627:therapeutic use*; D010446:Peptide Fragments / Q000097:blood; D011247:Pregnancy; D011274:Pregnancy, Tubal / Q000097:blood / Q000188:drug therapy* / Q000473:pathology; D014327:Trophoblasts / Q000473:pathology; D014463:Ultrasonography; D014621:Vagina
D006063:Chorionic Gonadotropin; D018997:Chorionic Gonadotropin, beta Subunit, Human; D010446:Peptide Fragments; D008727:Methotrexate