The use of methotrexate to treat ectopic pregnancy was introduced in the 1990s.In 1982, Tanaka et al. was the first to treat intramural pregnancy with methotrexate successfully (1). More recently, Ory et al.(2) and then Stovall et al.(3) used methotrexate to treat unruptured ectopic pregnancies. Stovall et al. created the nonlaparoscopic diagnostic algorithm for ectopic pregnancy, which included serial assay of b-hCG, progesterone levels, transvaginal ultrasound and curettage (4). In our six year study we qualified for conservative therapy 51 patients with unruptured ectopic pregnancy. We treated these patients with a single dose of methotrexate (50 mg/m 2 ). Our results are compared to those of other authors who used similar diagnostic and therapeutic techniques. Materials and methodsFrom 1993 to 1998 we treated 300 patients for ectopic pregnancy. Fifty-one patients (17%) were diagnosed with unruptured ectopic pregnancy with a nonlaparascopic algorithm proposed by Stovall et al. In patients where ectopic pregnancy was suspected, a gynecological examination was performed once by one gynecologist. To assay the Abbreviation: b-hCG: beta-human chorionic gonadotropin.C Acta Obstet Gynecol Scand 78 (1999) concentration of b-hCG we used IMx System produced by Abbott, referenced against the WHO Third International Standard 75/537. After patient consent was obtained, the 51 patients were qualified for conservative pharmacological treatment. We administered methotrexate in a single dose (50 mg/m 2 ) intramuscularly. All patients were in good health and without hemodynamic dysfunction. Hepatic, renal, and hematological diseases were ruled out. In all patients blood counts, transaminase, urea and creatinine levels were in the normal range. Therapy was monitored by assessing the general state of the patient and assay of b-hCG the day of methotrexate administration and 48 hours later. Seven days after methotrexate administration blood counts, transaminase, urea and creatinine concentration were evaluated. Patients with Rh minus were given anti D immunoglobulin. Transvaginal ultrasound was repeated only in the cases of abdominal pain and in cases where fetal heart beat had been observed. We observed these patients until the fetal heart beat ceased. If between the fourth and seventh day from methotrexate administration b-hCG had decreased 15% or less we did not administer a second dose. In the remainder we administered a second identical dosage 7 days after the first dose. We observed all patients until the b-hCG concentration was ∞2 mIU/ml. After treatment we assessed the patency of the tubes by hysterosalpingography in all patients desiring fertility.
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