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.
Ménard
A
A
Department of Gynecology and Obstetrics, University of Paris VII, Xavier-Bichat School of Medicine, France.
Créquat
J
J
Mandelbrot
L
L
Hauuy
J P
JP
Madelenat
P
P
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