A Clinical Study of Unruptured Ectopic Pregnancies with the Treatment of Systemic or Local Methotrexate Injecton.
- Author:
Hyun Haing LEE
;
Yong Sung CHOI
;
Suk Kyung KIM
;
Eun Hye LEE
;
Yu Seon MIN
;
Sang Hee LEE
;
Yoo Mee LEE
;
Hyeon Chul KIM
;
Tae Won SUNWOO
;
Chan LEE
;
Sung Woon CHANG
;
Sun Hee CHA
;
Jin Ho CHO
- Publication Type:Comparative Study ; Original Article
- Keywords:
Methotrexate, unruptured ectopic pregnancy
- MeSH:
Cesarean Section;
Cicatrix;
Diagnosis;
Female;
Follow-Up Studies;
Gestational Age;
Humans;
Methotrexate*;
Pregnancy;
Pregnancy, Ectopic*;
Pregnancy, Tubal;
Ultrasonography
- From:Korean Journal of Obstetrics and Gynecology
2000;43(4):616-624
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
OBJECTIVE: To evaluate safety and efficacy of systemic or local methotrexate(MTX) injection to patients with unruptured ectopic pregnancy METHODS: From October 1995 to October 1999, 35 unruptured ectopic pregnancies were eligible for the conservative management. 25 tubal pregnancies, 4 cervical pregnancies, 4 pregnancies of previous cesarean section scar, and 2 cornual pregnancies diagnosed by ultrasonography & serumbeta-hCG were evaluated. Patients were treated with one of following three protocols : (1) A single-dose of 50mg/m2 of intramuscullar(IM) MTX(7 cases) (2) Two to four doses of 1.0mg/kg of IM MTX with citrovorum rescue(20 cases) (3) Transvaginal ultrasonogram-guided intra-amniotic instillation of 50mg methotrexate (8 cases) The mean age of these patients was 30.8 yrs (range 24-42) and gestational age at diagnosis ranged from 22-75 days (mean 47). Initial level of serumbeta-hCG ranged from 166.4-55363.8 mIU/mL (mean 9069.2). Patients were monitored with serumbeta-hCG titers three times per week ,and then weekly until the serumbeta-hCG level was less then 10 mIU/mL. RESULT: 31 of 35 patients (88.6%) were successfully treated and remaining 4 patients failed conservative therapy and so required surgery. Mean duration of resolution was 38.5 days (range 11-105). Side effect rate was 45.7% but severity of symptoms were so mild that no treatment was needed in most cases. CONCLUSION: Nonsurgical conservative management of MTX appears to be effective and safe treatment modality for some selected unruptured ectopic pregnancy. But further comparative studies and long-term follow-up are needed to evaluate reproductive outcome and reduce side effects of MTX.
