Late complications after systemic methotrexate treatment of unruptured ectopic pregnancies: a report of three cases.
BACKGROUND
The use of methotrexate (MTX) by systemic administration in the treatment of unruptured ectopic pregnancy has been reported as a safe and effective method.


METHODS
We report three cases (one hematosalpinx and two pelvic hematocoeles) of complications after the use of MTX in the treatment of unruptured ectopic pregnancies. All three cases came to our observation for pelvic pain, abnormal bleeding and a pelvic mass after an interval of 3-5 months, subsequent to the disappearance of symptoms and normalization of serum human chorionic gonadotropin beta-subunit (beta-hCG) levels.


CONCLUSIONS
These findings suggest that: (a) such complications should be considered before selecting the mode of treatment for ectopic pregnancy; and (b) that an early ultrasonographic control should be performed after MTX treatment even when the decline in beta-hCG levels suggests a successful resolution. This would permit an early diagnosis of these late complications.
Zullo
F
F
Department of Gynecologic and Pediatric Sciences, Reggio Calabria University, Catanzaro, Italy.
Pellicano
M
M
Di Carlo
C
C
De Stefano
R
R
Mastrantonio
P
P
Nappi
C
C
D000328:Adult; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood; D005184:Fallopian Tube Diseases / Q000139:chemically induced* / Q000000981:diagnostic imaging; D005260:Female; D006398:Hematocele / Q000139:chemically induced* / Q000000981:diagnostic imaging; D006470:Hemorrhage / Q000139:chemically induced* / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000009:adverse effects* / Q000627:therapeutic use; D010388:Pelvis; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000188:drug therapy*; D014463:Ultrasonography
D018997:Chorionic Gonadotropin, beta Subunit, Human; D008727:Methotrexate