Medical treatment of ectopic pregnancy with methotrexate.
OBJECTIVE
To review our experience with low-dose IM methotrexate for the medical management of ectopic pregnancy (EP).


METHODS
Retrospective chart review.


METHODS
Magee-Womens Hospital, Pittsburgh, Pennsylvania.


METHODS
The first 50 women treated by the resident service in whom EP was diagnosed and treated with methotrexate.


METHODS
Intramuscular methotrexate, 50 mg/m2. Serum beta-hCG was evaluated 4 and 7 days after treatment and then weekly thereafter. The dose was repeated if the beta-hCG level did not drop > or = 15% between days 4 and 7 or if a plateau or rise was noted during weekly follow-up evaluation. Surgery was performed if significant abdominal pain occurred in the presence of hemodynamic instability or signs of peritoneal irritation on physical examination.


METHODS
Resolution of the EP without surgical intervention.


RESULTS
Two patients were lost to follow-up and one was treated without a certain diagnosis of EP. Forty-three of the remaining 47 women (91.5%; 95% confidence interval, 83.5%, 99.5%) were treated successfully with methotrexate. Of these, 36 women were treated with a single dose, and 7 required a second dose. Four women were treated surgically after medical management failed. The time from initiation of treatment to cure in women who were treated successfully was 25 +/- 15 days (mean +/- SD). Thirteen patients (27.7%) made additional visits to the emergency department because of increased abdominal pain.


CONCLUSIONS
As medical therapy for EP becomes common practice, familiarity with its side effects may lead to greater success rates. The decision to abandon medical treatment and proceed with surgery should be based on defined guidelines, such as the development of peritoneal signs, decreasing hemoglobin levels, or hemodynamic instability.
Thoen
L D
LD
Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Magee-Womens Hospital, Pennsylvania 15213-3180, USA.
Creinin
M D
MD
D015746:Abdominal Pain / Q000209:etiology / Q000601:surgery; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D008499:Medical Records; D008727:Methotrexate / Q000627:therapeutic use*; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000150:complications / Q000188:drug therapy* / Q000601:surgery; D019233:Retreatment; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
D018997:Chorionic Gonadotropin, beta Subunit, Human; D008727:Methotrexate