Methotrexate for the treatment of unruptured tubal pregnancy: a prospective nonrandomized study.
OBJECTIVE
The aim of this study was to compare in a prospective nonrandomized study, the efficacy of 2 methods of administering methotrexate (MTX) in the treatment of ectopic pregnancy (EP): transvaginal injection under sonographic control or intramuscular injection (IM).


METHODS
Patients with EP who met specific inclusion criteria for medical treatment were treated with MTX: 63 patients (group 1) were treated by IM and 47 patients (group 2) by transvaginal local injection. In group 1, 50 mg/m2 of MTX was injected intramuscularly; in group 2, transvaginal injection of 1 mg/kg of MTX was injected into the ectopic sac under sonographic control. When an additional dose of MTX was required, it was administrated IM at the dosage of 50 mg/m2 in both groups.


RESULTS
The overall success rate, defined by a posttreatment normal hCG level (< 10 mUI/mL) was 71.4% in group 1 versus 91.5% in group 2 (P < 0.01); for patients with hCG levels < 2000 mUI/mL, 83% and 96%, respectively (not significant); for patients with hCG > or = 2000 mUI/mL, 37.5% and 86.4%, respectively (P < 0.01).


CONCLUSIONS
In the medical treatment of EP, the efficacy of MTX is greater when administered by local transvaginal injection than by IM injection. We propose local treatment every time EP can be punctured, especially when hCG levels are > or = 2000 mUI/mL.
Gervaise
Amélie
A
Service de Gynécologie-Obstétrique, Université Paris-Sud, Hôpital Antoine Béclère (AP-HP), Clamart, France.
Capella-Allouc
Sylvie
S
Audibert
François
F
Rongières-Bertrand
Catherine
C
Vincent
Yves
Y
Fernandez
Hervè
H
D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage*; D000328:Adult; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D007267:Injections / Q000379:methods; D007273:Injections, Intramuscular; D008727:Methotrexate / Q000008:administration & dosage*; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000188:drug therapy*; D011446:Prospective Studies; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D014621:Vagina
D000020:Abortifacient Agents, Nonsteroidal; D008727:Methotrexate