Single-dose methotrexate for treatment of ectopic pregnancy

Article Abstract:

An ectopic pregnancy is one in which the fertilized egg becomes implanted outside of the uterus. The drug methotrexate has been shown to be effective in treating ectopic pregnancy that has not ruptured. Methotrexate is combined with citrovorum factor, which is used to rescue normal cells after destruction of the rapidly growing fetal cells by methotrexate. Methotrexate and citrovorum factor are administered to patients until levels of human chorionic gonadotropin (hCG), a hormone released by the placenta and a marker for pregnancy, were reduced by 15 percent on two consecutive days. Fifteen to 20 percent of patients required only a single dose of methotrexate. A specific protocol was devised for the nonsurgical diagnosis of ectopic pregnancy and was shown to be 100 percent accurate. The effectiveness of nonsurgical diagnosis and the single-dose methotrexate regimen in the management of ectopic pregnancy was assessed. Methotrexate was administered as a single dose into the muscle without the addition of citrovorum factor to 30 patients with an ectopic pregnancy measuring 3.5 centimeters or less. The average age of the patients was 28.5 years and most had three previous pregnancies. Nine of the 30 patients had a previous ectopic pregnancy, which was removed during salpingectomy, or the surgical removal of the fallopian tubes. Ultrasonography, a method in which sound waves are used to visualize internal structures, detected the ectopic pregnancy in 28 patients and fetal heart activity in six. The levels of hCG continued to rise three days after methotrexate injection but started to decline within a week. A second dose of methotrexate was not required and drug treatment was not associated with adverse effects. Methotrexate treatment was successful in 29 patients, although two of six patients with lower abdominal pain between days 5 and 10 were hospitalized overnight. Five of the six cases of ectopic pregnancies with embryonic heart activity were successfully treated. These findings show that a single dose of methotrexate provides a safe, effective, and less expensive method of treating ectopic pregnancy of 3.5 centimeters or less. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Measurement, Chorionic gonadotropin, Chorionic gonadotropins

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Methotrexate therapy for persistent ectopic pregnancy after conservative laparoscopic management

Article Abstract:

Ectopic pregnancy (implantation of the embryo in a site other than the uterine cavity) is much less dangerous than in previous decades, due largely to diagnostic methods that allow for earlier detection. Surgical removal of the embryo and supporting structures is incomplete in many cases, however, and almost 5 percent of women undergoing laparoscopic surgery (conducted by means of a small abdominal incision) for ectopic pregnancy require another procedure. Because this second surgery can further compromise fertility, drug treatment with agents that are toxic to the trophoblast (the residual tissue) may be an acceptable alternative. Results are presented of administering methotrexate (a chemotherapeutic drug that acts against rapidly developing cells) and citrovorum factor (folic acid; to prevent widespread toxicity) to three women who had undergone laparoscopic surgery for ectopic pregnancies in the fallopian tubes. Treatment was started because blood tests indicated that trophoblastic tissue was still present. During the drug therapy, the patients experienced mild cramps, but no other side effects; over a period of several weeks, hormone levels returned to normal (nonpregnant status). A brief discussion of the optimal methotrexate dosage is presented. Results have not been reported regarding subsequent attempts to conceive by these patients or the two others in the medical literature who underwent similar methotrexate treatment. This approach should be considered for cases in which additional surgery for ectopic pregnancy is to be avoided. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Case studies, Complications and side effects, Dosage and administration, Laparoscopy

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