title: A systematic review of single-dose intramuscular methotrexate for the treatment of ectopic pregnancy.
abstract: The use of single-dose intramuscular methotrexate for the primary treatment of ectopic pregnancy is increasing in frequency in many countries. We performed a systematic review of all available studies and case reports of intramuscular methotrexate to examine the therapeutic efficacy, side-effects and complication rates of this new treatment approach. The pooled data show a successful resolution rate of 71% (95% confidence interval 58% to 81%) after a single dose of intramuscular methotrexate and 84% (95% confidence interval 77% to 90%) after 1 or 2 doses. Side-effects were experienced by 24% (95% confidence interval 9% to 47%) of patients and 10% (95% confidence interval 7% to 14%) had a ruptured ectopic pregnancy. The pooled data show that single-dose intramuscular methotrexate is associated with a high failure rate. Follow-up is prolonged and there is a significant incidence of minor side-effects. Serious complications and side-effects have occurred. The use of intramuscular methotrexate should be confined to clinical trials until more evidence is obtained to support its more widespread use.
authors.affiliation: Division of Obstetrics and Gynaecology, John Hunter Hospital, Newcastle, New South Wales.
authors.forename: J
authors.initials: J
authors.lastname: Parker
authors.forename: A
authors.initials: A
authors.lastname: Bisits
authors.forename: A M
authors.initials: AM
authors.lastname: Proietto
mesh_terms: D000328:Adult; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D008727:Methotrexate / Q000008:administration & dosage* / Q000009:adverse effects; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000188:drug therapy* / Q000401:mortality; D011274:Pregnancy, Tubal / Q000188:drug therapy / Q000401:mortality; D012307:Risk Factors; D012422:Rupture, Spontaneous; D016019:Survival Analysis; D017211:Treatment Failure
chemical_list: D008727:Methotrexate