Methotrexate versus hyperosomolar glucose in the treatment of extrauterine pregnancy.
The aim of this prospective, randomized, double blind study was to compare the efficacy of methotrexate and hyperosmolar glucose injected directly into the extra-uterine gestational sac under laparoscopic vision. The study included twenty women with ectopic pregnancy. Inclusion criteria were intact tubal pregnancy, not exceeding 4 cm in diameter, rising or plateauing betahCG levels, and no evidence of intra-abdominal bleeding. The patients were treated by laparoscopically guided injection of 3 mL fluid into the area containing the tubal pregnancy. The fluid contained either 25 mg methotrexate (n=9) or 50% glucose (n=9). Daily decrease in betahCG levels was faster in patients treated by methotrexate (median 8.7%) than in those treated by hyperosmolar glucose (median 4.8%), p=0.17. The study was discontinued due to a higher failure rate in the group treated by hyperosmolar glucose. In conclusion, local injection of methotrexate is superior to hyperosmolar glucose. It can be used as an alternative to salpingostomy or salpingotomy whenever laparoscopy is performed for the diagnosis and treatment of extra-uterine pregnancy.
Sadan
O
O
Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Sackler Faculty of Medicine, Tel Aviv University, Israel.
Ginath
S
S
Debby
A
A
Rotmensch
S
S
Golan
A
A
Zakut
H
H
Glezerman
M
M
D000328:Adult; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood; D004311:Double-Blind Method; D005260:Female; D005493:Folic Acid Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D005947:Glucose / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D006982:Hypertonic Solutions; D008727:Methotrexate / Q000008:administration & dosage / Q000627:therapeutic use*; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000188:drug therapy*; D011446:Prospective Studies; D013762:Tetrahydrofolate Dehydrogenase
D018997:Chorionic Gonadotropin, beta Subunit, Human; D005493:Folic Acid Antagonists; D006982:Hypertonic Solutions; D013762:Tetrahydrofolate Dehydrogenase; D005947:Glucose; D008727:Methotrexate