title: Success and spontaneous pregnancy rates following systemic methotrexate versus laparoscopic surgery for tubal pregnancies: a randomized trial.
abstract: OBJECTIVE
  To determine which treatment should be offered to women with a non-ruptured tubal pregnancy: a single dose of methotrexate (MTX) or laparoscopic surgery.
  
  
  METHODS
  Prospective, randomized, open multicenter study.
  
  
  METHODS
  Seven Danish departments of obstetrics and gynecology.
  
  
  METHODS
  A total of 106 women diagnosed with ectopic pregnancy (EP).
  
  
  METHODS
  Between March 1997 and September 2000, 1,265 women were diagnosed with EP, 395 (31%) were eligible, 109 (9%) were randomized of whom 106 had an EP. The study was originally powered to a sample size of 422 patients. The women were randomized to either medical (MTX; 53) or surgical (laparoscopic salpingotomy; 53) treatment. Follow-up by questionnaire and through national patient databases for a maximum of 10 years.
  
  
  METHODS
  Uneventful decline of plasma-human chorionic gonadotropin to less than 5 IU/L, rates of spontaneous, subsequent intrauterine, and recurrent ectopic pregnancies.
  
  
  RESULTS
  The success rates were 74% following MTX treatment and 87% after surgery (n.s.); the subsequent spontaneous intrauterine pregnancy rate was 73% after MTX and 62% after surgery; and the EP rate was 9.6% after MTX and 17.3% following surgery (n.s.).
  
  
  CONCLUSIONS
  In women with an EP, who are hemodynamically stable and wishing to preserve their fertility, medical treatment with single dose MTX tends to be equal to treatment with laparoscopic surgery regarding success rate, complications, and subsequent fertility. Although the two treatment modalities seemed to be similar in outcome, it is crucial that the diagnosis is based on a high-quality ultrasonographic evaluation, as two patients had intrauterine pregnancies despite fulfilling the diagnostic algorithm for EP.
authors: Department of Obstetrics and Gynecology, Hvidovre Hospital, Hvidovre, Denmark. lkm@daldnet.dk
authors: Lars Bo
authors: LB
authors: Krag Moeller
authors: Charlotte
authors: C
authors: Moeller
authors: Sten Grove
authors: SG
authors: Thomsen
authors: Lars Franch
authors: LF
authors: Andersen
authors: Lene
authors: L
authors: Lundvall
authors: Øejvind
authors: Ø
authors: Lidegaard
authors: Jens Joergen
authors: JJ
authors: Kjer
authors: Jens Lindgren
authors: JL
authors: Ingemanssen
authors: Vibeke
authors: V
authors: Zobbe
authors: Charlotte
authors: C
authors: Floridon
authors: Janne
authors: J
authors: Petersen
authors: Bent
authors: B
authors: Ottesen
mesh_terms: D000328:Adult; D006063:Chorionic Gonadotropin / Q000097:blood; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008727:Methotrexate / Q000627:therapeutic use*; D008875:Middle Aged; D011247:Pregnancy; D011274:Pregnancy, Tubal / Q000097:blood / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000601:surgery*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D014463:Ultrasonography; D055815:Young Adult
chemical_list: D006063:Chorionic Gonadotropin; D008727:Methotrexate