title: Single-dose methotrexate treatment for ectopic pregnancy and pregnancy of unknown location and progesterone as a predictor of success.
abstract: BACKGROUND
  The use of single-dose intramuscular administration of methotrexate in the treatment of ectopic pregnancies (EP) is a well-established practice. This study evaluates its use at a novel dose of 40 mg/m(2) body surface area (BSA).
  
  
  OBJECTIVE
  To evaluate the efficacy and safety of single-dose methotrexate treatment 40 mg/m(2) for tubal EP and persistent pregnancies of unknown location (PUL) and determine whether serum progesterone is a predictor of treatment success.
  
  
  METHODS
  Retrospective cohort study of patients receiving intramuscular methotrexate 40 mg/m(2) for the treatment of EP or PUL at Royal Prince Alfred Hospital over five years.
  
  
  RESULTS
  One hundred and eighteen women received single-dose methotrexate with an overall success of 84%. Surgical intervention was needed in 16.6%. Pretreatment beta-hCG level and ectopic diagnosis were independent variables predictive of the need for surgery (P = 0.003 and 0.02, respectively). Serum progesterone level was not predictive of the need for a second dose or surgery. The sensitivity and specificity at pretreatment beta-hCG of 1202 IU/L were 84% and 74%, respectively. Commonly reported side effects included nausea, abdominal pain and heavy vaginal bleeding. Significant treatment-related adverse effects were rare.
  
  
  CONCLUSIONS
  Single-dose IM methotrexate at a novel dose of 40 mg/m(2) is a safe and effective treatment for selected EP and persistent PUL. The risk of surgery was positively correlated to serum beta-hCG level and the diagnosis of EP. Progesterone was not a risk factor for surgery. Further studies are required to confirm the efficacy of this dose regimen and explore the safety of expectant management as an alternative to methotrexate treatment.
authors.affiliation: RPA Women and Babies, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
authors.forename: Joyce
authors.initials: J
authors.lastname: Wu
authors.forename: Joanne P
authors.initials: JP
authors.lastname: Ludlow
authors.forename: Bradley
authors.initials: B
authors.lastname: De Vries
authors.forename: Kirsten
authors.initials: K
authors.lastname: Black
authors.forename: Philip
authors.initials: P
authors.lastname: Beale
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage* / Q000009:adverse effects; D000328:Adult; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood*; D005260:Female; D006801:Humans; D008727:Methotrexate / Q000008:administration & dosage* / Q000009:adverse effects; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000097:blood / Q000188:drug therapy* / Q000601:surgery; D011374:Progesterone / Q000097:blood*; D012189:Retrospective Studies
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D018997:Chorionic Gonadotropin, beta Subunit, Human; D011374:Progesterone; D008727:Methotrexate
keywords: ectopic pregnancy; medical management of ectopic pregnancy; methotrexate; pregnancy of unknown location; progesterone