Ectopic pregnancy, methotrexate, medical management, safety
Abstract
Systemic Methotrexate has been widely used to treat ectopic pregnancy.The aim of current study were to evaluate the safety and efficacy of single dose intramuscular methotrexate as a treatment option for early unruptured ectopic pregnancies. From 1st of January 2007 to 1st of January 2009 at Maternity teaching Hospital-Erbil, a case cohort prospective study was conducted on 60 patients with small unruptured ectopic pregnancies treated as in-patients with single dose of Methotrexate therapy.
Ectopic pregnancy was diagnosed by both transvaginal ultrasound for the size and volume of the gestational mass and β- HCG measurement. Intramuscular methotrexate 50 mg/m2 was administered on days 1 and Serial ß-hcg was repeated on days 4 and 7, If the β-HCG on day 7was at least 15% lower than that on day 4, the patient was regarded as treatment success, and Followup serum ß-HCG was performed weekly until become negative ( value of <15 mIU/ml). while additional doses(second dose) of methotrexate were given on day 7 If the ß-HCG level on day 7 was the same or higher or less than 15% lower than that on day 4. The success rate of systemic methotrexate (single dose) was 75%(n 45), 25%(n=15) exposed to 2 or more doses of methotrexate ,16.6%(n=10) of patients exposed to multidose methotrexate respond to treatment, remain only 8.3%(n=5) not respond to multidose treatment they were treated surgically ,in which 2 cases of them operation done for them on their request after one dose of methotrexate, and other 3 cases were failed to respond to medical treatment after receiving 3 dose of methotrexate. The over all success rate of treatment in our study(medical treatment) was 91%(n=55).Success rate was higher in patients whom with β-HCG was ≤ 1500 mIU .Treatment was well-tolerated; most side effects were reported as mild and transient. All cases respond to methotrexate reported satisfaction with this regimen. Within two years follow up visit 38 cases become pregnant , 2 of them developed recurrent ectopic pregnancy.
