Prophylactic methotrexate after linear salpingostomy: a decision analysis.
OBJECTIVE
To compare two strategies for managing women after linear salpingostomy for treatment of tubal pregnancy: observation and prophylactic methotrexate.


METHODS
Decision analysis.


METHODS
Outpatient tertiary-care center.


METHODS
One thousand hypothetical women treated with a linear salpingostomy for ectopic pregnancy.


METHODS
Observation after salpingostomy and treatment of persistent ectopic pregnancy with a single dose of methotrexate (current standard of care) versus treatment with prophylactic methotrexate at the time of salpingostomy.


METHODS
Number of ruptured ectopic pregnancies, surgical procedures, complications, and cost for each group (observation vs. prophylaxis).


RESULTS
Prophylactic methotrexate results in fewer cases of tubal rupture (0.4% vs. 3.7%) and fewer procedures (1.9% vs. 4.7%) at a lower cost ($67.55 less/patient) compared with observation alone. Methotrexate-associated complications occur more frequently with prophylaxis (5.5% vs. 0.8%). Certain conditions change which strategy is preferable. Observation is the best strategy when the persistent ectopic pregnancy rate is <9%, the success of prophylaxis is <95%, the complication rate associated with methotrexate is >18%, or the rupture rate of persistent ectopic pregnancies is <7.3%.


CONCLUSIONS
Prophylactic methotrexate at the time of linear salpingostomy for the treatment of ectopic pregnancy is preferable to observation as long as certain conditions exist.
Gracia
C R
CR
Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Brown
H A
HA
Barnhart
K T
KT
D000020:Abortifacient Agents, Nonsteroidal / Q000627:therapeutic use*; D015331:Cohort Studies; D003663:Decision Trees; D005260:Female; D006801:Humans; D008727:Methotrexate / Q000627:therapeutic use*; D011247:Pregnancy; D011274:Pregnancy, Tubal / Q000150:complications / Q000601:surgery*; D012422:Rupture, Spontaneous / Q000517:prevention & control; D012489:Salpingostomy / Q000009:adverse effects*
D000020:Abortifacient Agents, Nonsteroidal; D008727:Methotrexate