Safety and efficacy of systemic methotrexate in the treatment of unruptured tubal pregnancy

OBJECTIVE: To evaluate the safety and efficacy of single dose intramuscular methotrexate (MXT) as a treatment option for early unruptured ectopic pregnancies, and to compare the results with those of previously published studies.

METHODS: We performed a prospective study on 30 patients with small unruptured ectopic pregnancies treated with a single dose of MXT therapy in the Department of Obstetrics and Gynecology, Maternity and Children Hospital, Buraidah, Qassim, Kingdom of Saudi Arabia from January 2002 to June 2004.

RESULTS: The mean pretreatment level of beta-human chorionic gonadotropin (beta-hCG) was 2209 ± 1381 mIU/ml. Only 22 women (73.3%) were successfully treated with a single dose of MXT. Five women required a second injection, and one woman required a third dose. The combined success rate for medical management of ectopic pregnancy with 1-3 doses of MXT was 86.7% (26 women). Pretreatment beta-hCG levels were significantly lower in women who responded to single dose therapy than in those who required either multiple doses or who had failure of medical management (p<0.001). The mean time to resolution of beta-hCG was 32.5 ± 17 days. Higher pretreatment levels correlated with longer resolution time (p<0.001). Four women (13.3%) had a failure of medical management and required surgery.

CONCLUSION: In our series, MXT was successful in 26 women (86.7%). Women with a pretreatment beta-hCG level of 3000-4000 mIU/ml had a greater probability of requiring either surgical intervention or multiple doses of MXT. The potential for emergency surgery remains an important risk.