Safety and efficacy of systemic methotrexate in the treatment of unruptured tubal pregnancy.

OBJECTIVE

To evaluate the safety and efficacy of single dose intramuscular methotrexate (MXT) as a treatment option for early unruptured ectopic pregnancies, and to compare the results with those of previously published studies.

METHODS

We performed a prospective study on 30 patients with small unruptured ectopic pregnancies treated with a single dose of MXT therapy in the Department of Obstetrics and Gynecology, Maternity and Children Hospital, Buraidah, Qassim, Kingdom of Saudi Arabia from January 2002 to June 2004.

RESULTS

The mean pretreatment level of beta-human chorionic gonadotropin (beta-hCG) was 2209 +/- 1381 mIU/ml. Only 22 women (73.3%) were successfully treated with a single dose of MXT. Five women required a second injection, and one woman required a third dose. The combined success rate for medical management of ectopic pregnancy with 1-3 doses of MXT was 86.7% (26 women). Pretreatment beta-hCG levels were significantly lower in women who responded to single dose therapy than in those who required either multiple doses or who had failure of medical management (p<0.001). The mean time to resolution of beta-hCG was 32.5 +/- 17 days. Higher pretreatment levels correlated with longer resolution time (p<0.001). Four women (13.3%) had a failure of medical management and required surgery.

CONCLUSION

In our series, MXT was successful in 26 women (86.7%). Women with a pretreatment beta-hCG level of 3000-4000 mIU/ml had a greater probability of requiring either surgical intervention or multiple doses of MXT. The potential for emergency surgery remains an important risk.