title: Systemic methotrexate: An effective alternative to surgery for management of unruptured ectopic pregnancy.
abstract: BACKGROUND
  Medical management of an unruptured ectopic pregnancy with intramuscular methotrexate is a common and cost-effective alternative to surgery. Early diagnosis and timely institution of methotrexate has resulted in a dramatic decline in the morbidity, mortality and financial burden associated with ectopic pregnancy. The objective of our study was to evaluate the efficacy of medical management in a series of patients with unruptured ectopic pregnancy meeting the strict inclusion criteria.
  
  
  METHODS
  Multiple dose methotrexate regimen was utilized for the management of the cases. Parenteral methotrexate 1 mg/kg was administered on Day 1, Day 3, Day 5 and Day 7 whereas rescue dose of injection leucovorin 0.1 mg/kg was given on Day 2, Day 4, Day 6 and Day 8. Monitoring for the resolution of the ectopic was carried out with β-hCG, done on Day 1, Day 3, Day 5, and Day 7. Any value showing a decline of >15% of the baseline value led to the termination of treatment and only surveillance was carried out. If the decrease was <15%, treatment was continued.
  
  
  RESULTS
  Total 43 patients with ectopic pregnancy were diagnosed over a period of 1 year, conceived during infertility evaluation and treatment. 11 cases went directly for surgery whereas 32 were subjected to medical treatment. 75% of the patients got successfully treated and rest 25% required surgery following failed medical management.
  
  
  CONCLUSIONS
  Methotrexate therapy is a safe and effective alternative for the management of unruptured ectopic pregnancies with minimal or no side-effects and associated advantage of avoiding invasive surgery.
authors.affiliation: Senior Advisor (Obstetrics & Gynaecology), INHS Asvini, Colaba, Mumbai, India.
authors.forename: Pankaj
authors.initials: P
authors.lastname: Talwar
authors.affiliation: Classified Specialist (Obstetrics & Gynaecology), ART Centre, Army Hospital (R&R), New Delhi 10, India.
authors.forename: K
authors.initials: K
authors.lastname: Sandeep
authors.affiliation: Graded Specialist (Obstetrics & Gynaecology), ART Centre, Army Hospital (R&R), New Delhi 10, India.
authors.forename: Nikita
authors.initials: N
authors.lastname: Naredi
authors.affiliation: Consultant (Gynaec) & Endoscopic Surgeon, Ruby Hospital, Pune, Maharashtra, India.
authors.forename: B S
authors.initials: BS
authors.lastname: Duggal
authors.affiliation: Classified Specialist (Obstetrics & Gynaecology), Army Hospital (R&R), New Delhi 10, India.
authors.forename: Tony
authors.initials: T
authors.lastname: Jose
keywords: Ectopic pregnancy; Medical management; Methotrexate