Laparoscopic methotrexate instillation in unruptured tubal pregnancy--is it worthwhile?

This study documents the success rate and risks of laparoscopic local injection of methotrexate in the unruptured tubal pregnancy. This was a prospective study conducted in two centres, King Abdulaziz University Hospital and Dr Erfan & Bagedo Hospital, Jeddah, Saudi Arabia. Twenty-one patients with an intact tubal pregnancy were selected for laparoscopic local treatment with the use of a single injection of 12.5 mg of methotrexate into the ectopic site at the time of diagnostic laparoscopy. In 80.9% (17 patients), serum beta-hCG level decreased to the nonpregnant level with no further intervention and the patients recovered without any serious side effect. In 19.9% (four patients) mini-laparotomy was indicated because of a rising beta-hCG. Local methotrexate therapy in an early intact tubal ectopic at the time of laparoscopy is a possible alternative to surgery in selected cases. It also has some advantage over systemic (intramuscular) methotrexate as it avoids potentially serious side effects.