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Ultrasound-guided injection of methotrexate versus laparoscopic salpingotomy in ectopic pregnancy
H Fernandez1, S Pauthier, S Doumerc
1Department of Obstetrics and Gynecology, Hôpital Antoine Beclere, Clamart, France.
Objective:
To compare local injection of methotrexate (MTX) under sonographic control to laparoscopic salpingotomy for conservative management of ectopic pregnancy (EP).
Design:
Prospective randomized study.
Patients:
Forty patients were randomized into two groups using a random number table. Inclusion criteria were an EP visualized by ultrasound with a pretherapeutic score < or = 13 as assessed by six criteria graded from 1 to 3: gestational age, hCG level, P level, abdominal pain, volume of the hemoperitoneum, and diameter of the hematosalpinx.
Interventions:
Group 1 patients injected transvaginally with 1 mg/kg MTX into the EP without anesthesia versus group 2 patients undergoing laparoscopic salpingotomy.
Main Outcome Measures:
Postoperative hospital stay, decrease of hCG levels, success rate.
Results:
The success rates, defined by hCG levels returned to normal (< 10 mIU/mL [conversion factor to SI units, 1.00]), were 19 of 20 in both groups. Medical treatment was associated significantly with shorter postoperative stay (24 versus 46 hours) and a higher initial hCG level. Human chorionic gonadotropin returned to normal more quickly after laparoscopic treatment (14 versus 28 days).
Conclusions:
In selected cases of EP with a pretherapeutic score < or = 13, MTX treatment appeared to be as safe and efficient as was conservative treatment by laparoscopy.