title: Treatment of ectopic pregnancy by transvaginal intratubal methotrexate administration.
abstract: Twelve women with tubal pregnancies were treated with intratubal transvaginal methotrexate injection (1 mg/kg body weight). Serum beta-hCG levels decreased in all patients, and the resolution time from injection to undetectable beta-hCG levels was 14-120 days. In spite of declining serum beta-hCG and unruptured tubal pregnancy, two patients subsequently requested definitive treatment for their ectopic pregnancies and underwent surgery. Four of six women found to have a living embryo in their gestational sacs required a repeat methotrexate injection; one of these also required a local potassium chloride injection. The tubal pregnancies resolved in nine patients treated with methotrexate alone. During resolution, we noted a gradually increasing resistance index of the blood flow in the region of the gestation, but the tube became distended to 4.4 +/- 0.4 cm before gradually decreasing in size. No complications or side effects were encountered. These findings suggest that intratubal transvaginal methotrexate administration can provide a safe alternative to surgical treatment for patients with early unruptured tubal ectopic pregnancy. However, the presence of a living embryo makes the ectopic pregnancy more resistant to methotrexate treatment.
authors.affiliation: Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada.
authors.forename: T
authors.initials: T
authors.lastname: Tulandi
authors.forename: P M
authors.initials: PM
authors.lastname: Bret
authors.forename: M
authors.initials: M
authors.lastname: Atri
authors.forename: M
authors.initials: M
authors.lastname: Senterman
mesh_terms: D000328:Adult; D006063:Chorionic Gonadotropin / Q000097:blood; D005260:Female; D006801:Humans; D007267:Injections; D008727:Methotrexate / Q000008:administration & dosage / Q000627:therapeutic use*; D011247:Pregnancy; D011274:Pregnancy, Tubal / Q000097:blood / Q000188:drug therapy*
chemical_list: D006063:Chorionic Gonadotropin; D008727:Methotrexate