Medical management should be routinely used as primary therapy for ectopic pregnancy.
It does not appear that methotrexate can or should be used to totally replace laparoscopic salpingostomy. However, given its success rate in selected patients, its cost-effectiveness, and its low incidence of side effects, methotrexate therapy certainly can be used as an alternative therapy. The next step in developing this treatment option will be to conduct a randomized clinical trial comparing laparoscopic salpingostomy with intramuscular methotrexate. This type of study will answer questions regarding the patient's health related quality of life and economic impact of the two treatment modalities. For now, it seems prudent to offer methotrexate to those patients with an unruptured ectopic gestational mass 3.5 cm or less in greatest dimension.
Stovall
T G
TG
Section on Gynecology, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, NC 27157-1066, USA.
D006063:Chorionic Gonadotropin / Q000032:analysis; D003365:Costs and Cost Analysis; D005260:Female; D005493:Folic Acid Antagonists / Q000627:therapeutic use*; D006801:Humans; D008727:Methotrexate / Q000191:economics / Q000627:therapeutic use*; D011247:Pregnancy; D018873:Pregnancy Rate; D011271:Pregnancy, Ectopic / Q000188:drug therapy* / Q000191:economics / Q000378:metabolism
D006063:Chorionic Gonadotropin; D005493:Folic Acid Antagonists; D008727:Methotrexate