Single Dose Methotrexate as a Primary Treatment of Ectopic Pregnancy

Abstract

Objectives: To determine the efficacy of single-dose intramuscular methotrexate as the primary treatment of ectopic pregnancy.Study design: A hospital based- cohort clinical study.Setting: The study was carried out in the Department of Obstetrics and Gynecology in Al-Yarmouk teaching hospital.Methods: A hospital based- cohort study was done from October 2004 to November 2005 in AL-Yarmook teaching hospital to a total of 82 women referred because of clinical suspicion of ectopic pregnancy. 35 women were excluded because they needed surgical interference, the remaining 47 patients with clinical suspicion of ectopic pregnancy, made using a combination of β-hCG titers with ultrasound. 50 mg intramuscular methotexate regimen was given, β-hCG levels were measured on days 1,4,7 and then weekly . If β-hCG levels were not dropping enough after 1 week, a second dose of methotrexate given. Successful treatment was defined as the resolution of ectopic pregnancy with a single dose without surgical interference. Results: Our over all success rate was 78.7 %( 37/47 women). The median pretreatment serum β-human chorionic gonadotropin level was lower in those women in whom treatment was successful compared with those women with treatment failure (974 vs. 3804 mIU/mL, P<0.05). In our study 37 of 47 patients with ectopic pregnancy the level of β-hCG dropped.Six of 47 patients the dose needed to be repeated for another one week and the level of β-hCG monitored after another one week and was droping; the remaining 4 patients need surgical interference. Conclusion: Single dose of IM methotrexate was associated with a high success rate in selected cases of ectopic pregnancy especially after exclusion of factors which causes treatment failure.Key words: Ectopic pregnancy, Methotrexate