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Published on: February 28, 2014
Transvaginal intratubal methotrexate treatment of ectopic pregnancy
1Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada.
Objective:
To evaluate the efficacy of transvaginal intratubal methotrexate (MTX) treatment of tubal ectopic pregnancy (EP).
Setting:
Outpatient setting in University Hospital.
Patients:
Forty women with early EP and rising serum beta-human chorionic gonadotropin (beta-hCG) levels.
Intervention:
Transvaginal intratubal administration of MTX (1 mg/kg body weight).
Main Outcome Measures:
Success was defined as declining serum beta-hCG to undetectable levels, no tubal dilatation on ultrasound examination, and no further intervention was required.
Results:
Treatment was associated with a 70% success rate. No difference was found in the success rate between women with an embryo (76.9%) and those with no embryo in their fallopian tubes (66.7%). The initial serum beta-hCG levels were also not different between patients who were successfully treated and those who failed to respond to the treatment. Despite declining serum beta-hCG levels, tubal rupture occurred in two patients.
Conclusions:
Treatment of EP by transvaginal MTX administration is associated with a 70% success rate. This is independent of the presence of an embryo or the initial serum beta-hCG levels. Rupture of EP can still occur despite low and declining serum beta-hCG levels.
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