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Systemic treatment of ectopic pregnancies with single-dose methotrexate
1Department of Obstetrics and Gynaecology, University of Frankfurt am Main, Theodor-Stern-Kai 7, D-60590 Frankfurt/Main, Germany.
Study Objective:
To evaluate the success rate, side effects, reproductive outcome, and possible pitfalls of systemic low-dose methotrexate (MTX) for treatment of ectopic pregnancy (EP).
Design:
Longitudinal, nonrandomized trial Setting. Department of Obstetrics and Gynaecology at a teaching hospital in Germany.
Patients And Interventions:
Forty women with EP were treated with a single dose of MTX 20 to 40 mg intravenously. The highest pretreatment human chorionic gonadotropin (hCG) titer was 21,100 mIU/ml.
Measurements And Main Results:
Thirty-seven patients (92.5%) were treated successfully. Thirty-four (85%) received a single dose of MTX. Six (15%) required a second dose about a week later. Three patients (7. 5%) required surgical intervention. Serum MTX levels decreased below 0.1 micromol/L (45.4 microg/L) within 24 hours. In 53.8% of women hCG levels decreased directly after treatment; in 46.2% levels increased within the first 5 days after treatment.
Conclusions:
In selected patients, systemic low-dose MTX is an effective way to treat EP, and has no demonstrable side effects.