Efficacy of methotrexate in the treatment of nonruptured ectopic pregnancy, A six year experience at Polish Mother's Memorial Institute

Abstract

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.

Clinical and pregnancy outcome following ectopic pregnancy; a prospective study comparing expectancy, surgery and systemic methotrexate treatment

“…In the randomized study by Hajenius and co‐workers the success rate after laparoscopic diagnosis among patients treated with MTX was 82% (6). Other uncontrolled studies have reported success rates between 64% and 95% (2–5, 7–11). There are several possible explanations why our figure tends to be among the lower ones reported.…”

“…Methotrexate is a folic acid antagonist that has been used for many years for the treat-ment of trophoblastic disease. Although numerous studies have been published on the use and advantages of MTX for treatment of EP (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11), it was not until recently that the first randomized clinical trial on MTX versus laparoscopic salpingostomy or salpingectomy was published (6). The study by Hajenius and colleagues showed no difference between MTX treatment or surgery with respect to primary treatment success, tubal preservation, homolateral tubal patency on follow-up hysterosalpingography, or fertility outcome 18 months after completion of treatment (6,12).…”