Methotrexate in the management of adolescents with ectopic pregnancies: a physician survey

To assess gynaecologists' management of ectopic pregnancies in adolescents.

A survey was sent to Canadian gynaecologists, including pediatric gynaecologists, by mail and email. Pediatric gynaecologists in the United States were surveyed by mail. Variations in preferences and practices in the management of ectopic pregnancy were identified, with specific focus on the use of methotrexate. Some possible determinants of alternative management were described, using both descriptive and inferential statistics.

A total of 209 physicians responded. Of these, 89 (42.6%) had treated adolescents with ectopic pregnancies (the "treatment group"). There were no statistically significant differences in demographic characteristics of the treatment group compared with the non-treatment group, except for the proportion of adolescents in the physicians' practices and whether or not they provided care for pregnant adolescents. In the treatment group, 84.3% had used methotrexate in the management of adolescents with an ectopic pregnancy. Most physicians (57/89, 64%) stated that they do not use different criteria for managing adolescent and adult patients, although across all age categories only 21.3% to 25.8% stated that age is not a relevant factor; 43.9% and 28.8% would definitely not or probably not offer methotrexate to patients less than 13 and 14-16 years of age, respectively, and 4.8% and 6.2% would definitely not or probably not offer methotrexate to patients 17-19 and more than 19 years of age, respectively. Physicians would definitely not or probably not offer methotrexate to a patient with a history of non-compliance with contraception (48.4%) or of substance abuse (45.9%), or to a patient living alone (62.7%).

Physicians do report using methotrexate in managing adolescents with ectopic pregnancies, but consider age and compliance variables in their decision-making.