Ectopic pregnancy. Nonsurgical, outpatient evaluation and single-dose methotrexate treatment

Seventeen patients with suspected ectopic pregnancy (EP) were managed as outpatients with single-dose intramuscular methotrexate (MTX) in a community hospital. A nonsurgical method was utilized for evaluation based on transvaginal ultrasonography in combination with serum human chorionic gonadotropin (hCG) determination and performance of dilation and curettage (D&C). The mean pretreatment hCG concentration was 3,320.9 mIU/mL, with a range of 158-12,420. Sixteen of 17 (94.1%) patients responded successfully to therapy, with a mean duration until hCG resolution of 26.4 days (range, 12-55). One patient experienced rupture 14 days after treatment. One of 17 patients (5.9%) complained of increased abdominal pain six days after treatment and was managed without intervention. There were no reports of adverse effects from the chemotherapy. This study demonstrated that nonsurgical evaluation for presumed EP in carefully selected patients may be performed without D&C and managed safely and effectively with well-tolerated, single-dose, systemic MTX. Our approach was designed for community hospitals.