Success rate of methotrexate in the conservative treatment of tubal ectopic pregnancies

Abstract

An ectopic pregnancy (EP) involves the implantation of the gestational sac outside the uterine cavity. In the event of diagnosing an EP, the current medical approach is to avoid surgery and to preserve fertility whenever possible; therefore, methotrexate (MTX)-based therapy has become prominent in recent years. MTX, a drug usually used to treat severe forms of autoimmune diseases and several types of cancer, has proven its utility in the conservative treatment of EPs. The success rate of MTX correlates with lower values of β subunit of human chorionic gonadotropin hormone (β-hCG) serum levels, especially below 2,000 mUI/ml, side effects being insignificant. In the present study, the results obtained concerning the success rate of MTX in the conservative treatment of EPs were obtained at the Department of Obstetrics and Gynecology of the Bucharest University Emergency Hospital from January 2014 to December 2020. The aim of the present study was to highlight the necessity for revising current guidelines for ectopic pregnancy medical treatment in order to manage this pathology optimally and to select carefully the proper treatment, whether medical, surgical or expectant management, so that morbidity is reduced to a minimum.

Surgical treatment of interstitial pregnancy without cornual resection: A case report

“…[ 6 ] When the serum β-HCG exceeds 20,000 IU/L, poor response to MTX is highly likely and may warrant further surgical treatment; this is consistent with our case. [ 7 ] The widely used surgical intervention for IP is cornual wedge resection. The major disadvantage of this treatment is disruption of myometrial lining and therefore impairs fertility potential.…”

The evaluation of success and failure of methotrexate treatment in ectopic pregnancy

“…Although it has been known that high levels of pretreatment β-hCG are the most important predicting factor related to MTX treatment failure, it remains unclear which treatment modality is suitable for a specific range of pretreatment β-hCG values (22,28). Lipscomb et al (29) reported that the initial β-hCG value is the most important factor determining failure in single-dose regimen of MTX treatment.…”

Evaluation of pretreatment and early treatment changes in serum β-hCG with methotrexate

“…It was first identified for the treatment of tubal pregnancies by Stovall et al 1 The tubal EP and MTX treatment protocol have attracted the attention of researchers in recent years. [2][3][4][5][6][7][8][9][10][11][12][13][14][15] Jurkovic et al followed up EP with low serum beta-human chorionic gonadotropin (β-hCG) levels (<1500 IU/L) and confirmed the diagnose of EP by ultrasonography. They administered a single-dose injection of MTX at 50 mg/m 2 to the treatment group.…”

“…2 It has been stated that the success rate of MTX may be more effective in subgroups with lower values of serum β-hCG, especially below 2000 mUI/mL. 14 In another study, it has been suggested that MTX treatment administered as a single dose had increased success rates in EP with lower serum β-hCG at the start of treatment. They reported that changes in serum β-hCG within the first 4 days are important in determining the treatment protocol and efficacy.…”

“…10 Grigoriu et al reported that right salpingectomy was performed after unsuccessful MTX treatment. 14 Cohen et al observed that women with an increase in serum β-hCG >69% within 48 h prior to MTX had an 85% probability of tubal rupture, and that women with serum β-hCG elevation <20% had a lower absolute risk for tubal rupture. 12 They also reported that medical treatment with a single dose of oral mifepristone, as well as systemic multi-dose MTX with folinic acid were required when a living fetus and high serum β-hCG levels were present.…”