Treatment of unruptured ectopic pregnancy with methotrexate: A UK experience

Abstract

Ectopic pregnancy is an increasing health risk for women throughout the world. The modern diagnostic technology allows earlier detection of ectopic pregnancy. With early diagnosis there is a trend towards more conservative approach in the management. Although medical management with methotrexate has been used successfully in the USA for a decade, the experience in the UK is limited. A recent postal survey (1) has shown that less than 4% of hospitals in the UK are routinely using medical treatment for ectopic pregnancy. We report our experience in managing unruptured ectopic pregnancy with methotrexate.

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).…”

The Use of Intravenous Methotrexate in the Treatment of Ectopic Pregnancy

“…administration of MTX 6 . Recent studies have demonstrated its non-invasiveness, high efficiency and absence of systemic toxicity in a low single-dose treatment [7][8][9] .…”