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A medical management of interstitial ectopic pregnancy: a 5-year clinical study
Amy Tang1, David Baartz, Soo Keat Khoo
1Department of Obstetrics and Gynaecology, University of Queensland, Royal Brisbane and Women's Hospital, Brisbane, Australia.
Background:
Medical treatment of the rare interstitial ectopic pregnancy with methotrexate has been considered an alternative to surgical resection.
Aim:
To determine the treatment success rate with a single-dose intravenous methotrexate/folinic acid regimen and to identify predictors of treatment outcome.
Methods:
A 5-year audit (April 2000-August 2005) was carried out, collecting clinical imaging data and serum beta-human chorionic gonadotrophin (beta-hCG). Time taken for complete beta-hCG resolution was recorded, and a negative beta-hCG result was used as an endpoint of successful outcome.
Results:
Of the 13 cases, two required urgent surgery for rupture on presentation. In the remaining 11 cases, intravenous methotrexate (300 mg) was used, with oral folinic acid rescue (15 mg x 4 doses). There were no side-effects. Complete beta-hCG resolution was achieved in 10 of the 11 medically treated cases (91% success rate), requiring 21-129 days. Successful outcome was seen with initial beta-hCG level as high as 106 634 IU/L and gestation sac as large as 6 cm and a live fetus.
Conclusion:
The methotrexate/folinic acid regimen used as a one-dose treatment is safe and effective for unruptured interstitial pregnancy, with no side-effects and the advantage of avoiding invasive surgery. Subsequent tubal patency and reproductive function are yet to be ascertained.
