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Single high dose of local methotrexate for the management of relatively advanced ectopic pregnancies
J M Tzafettas1, A Stephanatos, A Loufopoulos
1Third Department of Obstetrics and Gynecology, Aristotle University, Hippokrateio Hospital, Thessaloniki, Greece.
Objective:
To evaluate the limits of the conservative management of relatively advanced ectopic pregnancies (EPs) with local methotrexate given at a higher than standard dose.
Design:
Nonrandomized prospective study.
Setting:
A tertiary teaching hospital and an affiliated infertility center.
Patient(S):
We treated 118 EPs of up to 56 days' gestation (8 weeks) regardless of the presence of fetal heart activity, the size of the gestational mass, and the initial beta-hCG levels.
Intervention(S):
Transvaginal intraamniotic or laparoscopic intratubal injection of 100 mg of methotrexate as a single dose.
Main Outcome Measure(S):
beta-hCG levels, red and white blood cell count, and liver function tests before and after methotrexate injection, followed by repeat transvaginal color Doppler assessments.
Result(S):
Treatment was successful in 105 (88.98%) of the 118 patients included in the study. In 7 of them with persistent fetal cardiac activity after the methotrexate injection, treatment was concluded with a complementary intracardiac injection of 10% KCl. No grade 3 or important clinical, hematologic, or biochemical toxicities occurred.
Conclusion(S):
Local administration of a single high dose of methotrexate (100 mg) proved safe and effective in the medical management of relatively advanced and unselected EPs, including cases with fetal heart activity, with high initial beta-hCG levels, and with a gestational mass beyond the standard maximum of 3.5 cm. Complementary hypertonic KCl proved to be effective in cases with persistent cardiac activity.