Medical treatment of ectopic pregnancy with methotrexate

LaRynda D. Thoen, Mitchell D Creinin

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

Objective: To review our experience with low-dose IM methotrexate for the medical management of ectopic pregnancy (EP). Design: Retrospective chart review. Setting: Magee-Womens Hospital, Pittsburgh, Pennsylvania. Patient(s): The first 50 women treated by the resident service in whom EP was diagnosed and treated with methotrexate. Intervention(s): Intramuscular methotrexate, 50 mg/m2. Serum β-hCG was evaluated 4 and 7 days after treatment and then weekly thereafter. The dose was repeated if the β-hCG level did not drop ≤15% between days 4 and 7 or if a plateau or rise was noted during weekly follow-up evaluation. Surgery was performed if significant abdominal pain occurred in the presence of hemodynamic instability or signs of peritoneal irritation on physical examination. Main Outcome Measure(s): Resolution of the EP without surgical intervention. Result(s): Two patients were lost to follow-up and one was treated without a certain diagnosis of EP. Forty-three of the remaining 47 women (91.5%; 95% confidence interval, 83.5%, 99.5%) were treated successfully with methotrexate. Of these, 36 women were treated with a single dose, and 7 required a second dose. Four women were treated surgically after medical management failed. The time from initiation of treatment to cure in women who were treated successfully was 25 ± 15 days (mean ± SD). Thirteen patients (27.7%) made additional visits to the emergency department because of increased abdominal pain. Conclusion(s): As medical therapy for EP becomes common practice, familiarity with its side effects may lead to greater success rates. The decision to abandon medical treatment and proceed with surgery should be based on defined guidelines, such as the development of peritoneal signs, decreasing hemoglobin levels, or hemodynamic instability.

Original languageEnglish (US)
Pages (from-to)727-730
Number of pages4
JournalFertility and Sterility
Volume68
Issue number4
DOIs
StatePublished - Oct 1997
Externally publishedYes

Fingerprint

Ectopic Pregnancy
Methotrexate
Abdominal Pain
Therapeutics
Hemodynamics
Lost to Follow-Up
Physical Examination
Hospital Emergency Service
Hemoglobins
Outcome Assessment (Health Care)
Guidelines
Confidence Intervals
Serum

Keywords

  • Ectopic pregnancy
  • Methotrexate
  • Ultrasound

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Medical treatment of ectopic pregnancy with methotrexate. / Thoen, LaRynda D.; Creinin, Mitchell D.

In: Fertility and Sterility, Vol. 68, No. 4, 10.1997, p. 727-730.

Research output: Contribution to journalArticle

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abstract = "Objective: To review our experience with low-dose IM methotrexate for the medical management of ectopic pregnancy (EP). Design: Retrospective chart review. Setting: Magee-Womens Hospital, Pittsburgh, Pennsylvania. Patient(s): The first 50 women treated by the resident service in whom EP was diagnosed and treated with methotrexate. Intervention(s): Intramuscular methotrexate, 50 mg/m2. Serum β-hCG was evaluated 4 and 7 days after treatment and then weekly thereafter. The dose was repeated if the β-hCG level did not drop ≤15{\%} between days 4 and 7 or if a plateau or rise was noted during weekly follow-up evaluation. Surgery was performed if significant abdominal pain occurred in the presence of hemodynamic instability or signs of peritoneal irritation on physical examination. Main Outcome Measure(s): Resolution of the EP without surgical intervention. Result(s): Two patients were lost to follow-up and one was treated without a certain diagnosis of EP. Forty-three of the remaining 47 women (91.5{\%}; 95{\%} confidence interval, 83.5{\%}, 99.5{\%}) were treated successfully with methotrexate. Of these, 36 women were treated with a single dose, and 7 required a second dose. Four women were treated surgically after medical management failed. The time from initiation of treatment to cure in women who were treated successfully was 25 ± 15 days (mean ± SD). Thirteen patients (27.7{\%}) made additional visits to the emergency department because of increased abdominal pain. Conclusion(s): As medical therapy for EP becomes common practice, familiarity with its side effects may lead to greater success rates. The decision to abandon medical treatment and proceed with surgery should be based on defined guidelines, such as the development of peritoneal signs, decreasing hemoglobin levels, or hemodynamic instability.",
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