Comparison of multidose and single-dose methotrexate protocols for the treatment of ectopic pregnancy

Lipscomb, Gary H.; Givens, Vanessa M.; Meyer, Norman; Bran, Derita

doi:10.1016/j.ajog.2004.12.061

Cited by 86 publications

(58 citation statements)

References 5 publications

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“…In our study there was no significant difference between groups about age of patients, gravidity, history of EP, infertility, contraceptive use, and size and location of ectopic mass similar to Barnhart et al and Lipscomb et al None of these variables would predicted the success of MTX treatment in this population study 26,27 . Logistic regression analysis demonstrated that day-1 and fall in 1-4 days β-hCG level was the significant independent variables for prediction of MTX treatment outcome.…”

Section: Discussionsupporting

confidence: 45%

Evaluation of Medical Treatment Success in Ectopic Pregnancy with Single Dose Methotrexate: 5 Year Experience

Yıldız¹,

Doğan²

2017

Kafkas J Med Sci

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(62.5% and 36.9% respectively, p<0.0001). The success rate was 95% when the levels were <1000 mIU/ml, 87.5% when the levels were between 1000-1999 mIU/ml and 35.5% when the levels were >5000 mIU/ml. Conclusion:Medical treatment with single dose systemic MTX may be an acceptable therapeutic option for ectopic pregnancy and MTX therapy is a safe and effective treatment modality for ectopic pregnancies with a serum BHCG levels below 3000 mIU/ml.

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Section: Discussionsupporting

confidence: 45%

Evaluation of Medical Treatment Success in Ectopic Pregnancy with Single Dose Methotrexate: 5 Year Experience

Yıldız¹,

Doğan²

2017

Kafkas J Med Sci

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“…Information was given to the patients to avoid vaginal intercourse, pelvic exams, sun exposure and non steroidal anti inflammatory drugs during treatment period. Paracetamol with or without codeine was given as pain relief [15]. Failed treatment was considered in both groups if; level of β-hCG had get higher or fallen by less than 15% at day 7, persisted at elevated levels for more than 6 weeks, or surgical interference was needed for any patient (elective or emergency).…”

Section: Methodsmentioning

confidence: 99%

Double Versus Single Dose Methotrexate Regimens in Management of Undisturbed Ectopic Pregnancy

Saleh¹

2016

OGIJ

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Objective: To assess the effectiveness and safety of double-dose methotrexate in comparing to single-dose methotrexate for management of ectopic pregnancy. Methods:A prospective randomized-controlled trial was conducted on 200 patients with ectopic pregnancy at the Obstetrics and gynecological Departments of Zagazig University, Egypt between June, 20 11 to May 2014. Patients were randomized into two groups, (group 1) who received a single dose 50 mg per meters squared surface area methotrexate (50 mg/m 2 IM on day 1) intramuscularly or (group 2), who received double-dose methotrexate regimen (50 mg/m 2 intramuscularly on days 1 and 4). The outcomes were; success rate, time duration of fall down of b-hcg to < 15 mlU/mL and undesirable effects of methotrexate. Results:In general, there is significant differences between both groups as regard the success rate and the duration of fall down β-hCG. The success rate was better in group 2 than in group 1 (90% versus 78.75%, P=0.01). The duration of fall down β-hCG until < 15 mlU/mL was shorter in group 2 (P=0.01). There was no significant difference between groups in adverse effects.Conclusion: Double-dose methotrexate as one of regimens of medical management of undisturbed ectopic pregnancy had more effectiveness and success rate than that of single-dose regimen with equivalent safety.

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“…Systemic MTX treatment against ectopic pregnancy has become routine [11], and the two most common protocols involve either a single- or multiple-dose regimens [9,10,11,13]. We selected the single-dose regimen [9] in 4 of the 5 cases because the single-dose regimen seemed to be as successful as the multiple-dose regimen [11,13], and it has been advocated to improve patient compliance and decrease side effects such as nausea, diarrhea, mouth sores, and an increase in liver transaminases [9,10].…”

Section: Discussionmentioning

confidence: 99%

“…Recently, there have been several reports describing successful laparoscopic surgery to remove gestational tissue for treatment of abdominal pregnancy [5,6,7,8]; however, the removal of gestational tissue creates a potential risk of catastrophic bleeding [2]. Systemic and/or local methotrexate (MTX) administration presents an alternative treatment for ectopic pregnancies [9,10,11,12,13,14]. However, a standardized strategy for treatment of abdominal pregnancy remains to be determined because of its rarity.…”

Section: Introductionmentioning

confidence: 99%

Successfully Treated Abdominal Pregnancy Causing Hemoperitoneum Using Combined Surgical and Systemic Methotrexate Therapy: A Case Report and Review of Cases Treated at Kyushu University Hospital

Yasutake

Tsunematsu

Oishi

et al. 2013

Gynecol Obstet Invest

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Abdominal pregnancy is a rare condition that accounts for only 1% of all ectopic pregnancies but results in high maternal morbidity and mortality. We present a case of abdominal pregnancy with massive peritoneal bleeding successfully treated using systemic methotrexate (MTX). A 34-year-old woman with amenorrhea for 8 weeks and a positive pregnancy test was referred for evaluation of ectopic pregnancy. Transvaginal ultrasonographic scan showed a gestational sac measuring 25 mm in diameter containing a viable embryo in the cul-de-sac and a considerable amount of free fluid in the patient's lower abdomen and pelvis. Laboratory parameters showed that her hemoglobin concentration was 5.8 g/dl and serum human chorionic gonadotropin concentration was 13,195 mIU/ml. Emergency surgery revealed an abdominal pregnancy in the cul-de-sac and a massive intra-abdominal hemorrhage. After a hemostasis procedure, the patient was successfully treated using systemic MTX. We also present the review of abdominal pregnancy cases treated using systemic MTX at our institution over 10 years. Systemic MTX treatment for abdominal pregnancy is safe and effective and makes it possible to avoid the risk of excessive bleeding by surgical resection of the implantation site.

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Comparison of multidose and single-dose methotrexate protocols for the treatment of ectopic pregnancy

Cited by 86 publications

References 5 publications

Evaluation of Medical Treatment Success in Ectopic Pregnancy with Single Dose Methotrexate: 5 Year Experience

Evaluation of Medical Treatment Success in Ectopic Pregnancy with Single Dose Methotrexate: 5 Year Experience

Double Versus Single Dose Methotrexate Regimens in Management of Undisturbed Ectopic Pregnancy

Successfully Treated Abdominal Pregnancy Causing Hemoperitoneum Using Combined Surgical and Systemic Methotrexate Therapy: A Case Report and Review of Cases Treated at Kyushu University Hospital

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