Clinical Guidelines for Methotrexate in Conservative Treatment for Ectopic Pregnancy.
- Author:
Kyung Ah JEONG
1
;
You Jung HAN
;
So Hyun LEE
;
Eun Kyoung SHIN
;
Eun Hee YOO
;
Shun Hee CHUN
;
Chong Il KIM
;
Joong Yol NA
;
Jae Seong KANG
Author Information
1. Department of Obstetrics and Gynecology, College of Medicine, Ewha Womans University, Korea.
- Publication Type:Original Article
- Keywords:
Ectopic pregnancy;
Methotrexate;
beta-hCG
- MeSH:
Fallopian Tubes;
Female;
Fertility;
Humans;
Leucovorin;
Methotrexate*;
Patient Selection;
Pregnancy;
Pregnancy, Ectopic*;
Retrospective Studies
- From:Korean Journal of Obstetrics and Gynecology
2005;48(11):2635-2644
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
OBJECTIVE: To provide more useful guidelines for methotrexate (MTX) treatment in ectopic pregnancy, including patient selection, therapeutic dose, and reproductive outcome. METHODS: Retrospectively, records of 54 patients treated for ectopic pregnancy with systemic MTX were reviewed. MTX was administered 1.0 mg/kg intramuscularly, alternatively with leucovorin 0.1 mg/kg intramuscularly for up to four daily doses of each drug. Samples for beta-hCG detection were obtained on days +3, +7 after beginning of the therapy and then weekly until values were undetectable. RESULTS: 50 patients (92.6%) were treated successfully. 4 patients (7.4%) for whom MTX therapy failed, were treated surgically. The endometrial thickness significantly increased in the failed group, compared to the successful group (14.3+/-4.0 mm vs 7.0+/-2.8 mm, P=0.0001). The serum hemoglobin levels significantly changed in the failed group, compared to the successful group (2.1+/-0.9 g/dL vs 1.0+/-0.8 g/dL, P=0.044). Patients were divided into increasing group and decreasing group according to beta-hCG levels on day 0, that were higher or lower than day -2 level. The resolution time of beta-hCG between increasing group and decreasing group was significantly different (27.6+/-14.0 days vs 17.7+/-8.6 days, p=0.016). In 8 patients (15.1%), an immediate rise of beta-hCG was recorded on day 3 after MTX treatment, but on day 7, a rapid decrease was recorded. Women were treated with significantly different therapeutic dose of MTX according to initial level of serum beta-hCG (p=0.021). There were mild complications (12%). MTX treatment preserved the fallopian tube and thus preserved fertility (70%). CONCLUSION: Systemic MTX use with the dose according to initial level of serum beta-hCG is a safe and highly effective treatment in clinically stable ectopic pregnancy.
