Evaluation of the success rate of medical management of ectopic pregnancy in a tertiary level teaching hospital in Kerala" during a three year period from October 2003 and September 2006

Abstract

Background: The incidence of ectopic pregnancy is on the rise owing to artificial reproductive techniques and higher number of patients with tubal pathology. Conservative management of ectopic pregnancy is especially important in couples who wish to preserve fertility and those who have had a previous salpingectomy now presenting with ectopic gestation on the other fallopian tube. Methotrexate an antineoplastic drug has revolutionized the conservative management of ectopic gestation with very few side effects on the pregnant woman. Conservative management of ectopic pregnancy by minimally invasive surgery has also gained popularity in recent times Objective: The purpose of this study is to report our experience with single and multiple doses of intramuscular methotrexate for the treatment of ectopic pregnancy Material and Methods: All patients who were diagnosed with an ectopic gestation between October 2003 and September 2006 at IMCH Kozikode, Kerala, India were evaluated .Those cases where the serum BhcG levels were up to 10,000 IU/mL with no intrauterine pregnancy, stable hemodynamic status, rising BhcG in the setting of a negative endometrial curettage and adenexal mass <4 cm were considered for conservative management with methotrexate. Results: The success rate of non surgical management of ectopic pregnancy as a function of initial beta hcG level was maximum when levels were <1000 mIU/ml and least when values were <10,000 .Beta hcG regression after methotrexate administration was faster with lower initial hormone levels Conclusion: Methotrexate is a revolutionary drug as far as conservative management of ectopic gestation is concerned. Success of treatment is maximum when the initial serum beta hcG levels are low.