Clinical Guidelines for Methotrexate in Conservative Treatment for Ectopic Pregnancy

Jeong, Kyung Ah; Han, You Jung; Lee, So Hyun; Shin, Eun Kyoung; Yoo, Eun Hee; Chun, Shun Hee; Kim, Chong Il; Na, Joong Yol; Kang, Jae Seong

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.