title: Effectiveness of medical treatment with methotrexate for interstitial pregnancy.
abstract: BACKGROUND
  In the last three decades, systemic methotrexate (MTX) has become widely accepted as the primary treatment for unruptured tubal pregnancy. This has prompted investigations into the use of MTX in the management of interstitial pregnancy.
  
  
  OBJECTIVE
  To determine the effectiveness of methotrexate for treatment of interstitial pregnancy.
  
  
  METHODS
  We retrospectively reviewed 17 haemodynamically stable women admitted to our tertiary, university-affiliated medical centre with an intact interstitial pregnancy from January 2003 through February 2013. First-line treatment consisted of intramuscular MTX 1 mg/kg/day x4 alternating with folinic acid 0.1 mg/kg or, in cases of low beta-human chorionic gonadotropin (β-hCG) and no embryonic pole, one dose of 50 mg/m(2) body surface area. Uterine artery MTX injection was administered on the ipsilateral side of the pregnancy followed by uterine artery embolisation as second-line treatment. Failure criteria were <15% decrease in β-hCG or sonographic evidence of pregnancy development. Second-line failures were referred for surgery.
  
  
  RESULTS
  Twelve women (70.5%) underwent successful first-line treatment and 5 (29.5%) required second-line treatment. Baseline characteristics were similar except for a higher rate of two previous ectopic pregnancies in the first-line failures (80% versus 8.3%, P = 0.01). Two women eventually required surgery, both with two previous ectopic pregnancies. Of the three women with fetal cardiac activity on admission, two had successful first-line treatment and one required surgery.
  
  
  CONCLUSIONS
  Systemic MTX is effective for treatment of intact interstitial pregnancy in haemodynamically stable women. The success rate is increased with uterine artery MTX injection as second-line treatment.
authors.affiliation: The Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Liran
authors.initials: L
authors.lastname: Hiersch
authors.forename: Haim
authors.initials: H
authors.lastname: Krissi
authors.forename: Eran
authors.initials: E
authors.lastname: Ashwal
authors.forename: Anat
authors.initials: A
authors.lastname: From
authors.forename: Arnon
authors.initials: A
authors.lastname: Wiznitzer
authors.forename: Yoav
authors.initials: Y
authors.lastname: Peled
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage / Q000627:therapeutic use*; D000328:Adult; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood; D005260:Female; D006801:Humans; D007269:Injections, Intra-Arterial; D007273:Injections, Intramuscular; D002955:Leucovorin / Q000627:therapeutic use; D008727:Methotrexate / Q000008:administration & dosage / Q000627:therapeutic use*; D011247:Pregnancy; D065167:Pregnancy, Interstitial / Q000097:blood / Q000000981:diagnostic imaging / Q000628:therapy*; D012008:Recurrence; D019233:Retreatment; D012189:Retrospective Studies; D017211:Treatment Failure; D014463:Ultrasonography; D055988:Uterine Artery; D055357:Uterine Artery Embolization; D014803:Vitamin B Complex / Q000627:therapeutic use
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D018997:Chorionic Gonadotropin, beta Subunit, Human; D014803:Vitamin B Complex; D002955:Leucovorin; D008727:Methotrexate
keywords: conservative management; interstitial pregnancy; systemic methotrexate; uterine artery embolisation