Comparison of single-dose and multiple-dose systemic methotrexate treatment followed by aspiration curettage and local methotrexate injection in treatment of cervical pregnancy

Lee, Il Han; Han, Seung Su; Kim, Dong Ho; Lee, Sang Hoon

Abstract

OBJECTIVE
To compare the clinical efficacy of systemic single-dose and multiple-dose methotrexate (MTX) regimens combined with aspiration curettage and local MTX in treatment of cervical pregnancy.
METHODS
Between January 2000 and December 2006, 40 cases of cervical pregnancies were treated with combined systemic and local methotrexate therapy at the Department of Obstetrics and Gynecology, Chung-Ang University Hospital. The patients were treated with either of the two regimens:a) Single dose regimen (Group 1): 1 mg/kg of intramuscular MTX with leucovorin treatment (18 cases).b) Multiple dose regimen (Group 2): four doses of 1 mg/kg of intramuscular MTX with leucovorin treatment (22 cases). Combination treatment with aspiration curettage and local MTX injection were done in all patients after clinically indicated.Baseline characteristics, regimens used and number of doses administered, treatment outcome, presence and severity of side effects were analyzed.
RESULTS
The mean age of the patients was 28+/-2.8 vs 28.4+/-2.4 years and gestational age at diagnosis was 49.4+/-8.3 vs 56.4+/-7.4 days. Initial level of serum beta-hCG ranges was 3,242.2+/-189.2 vs 2,864.3+/-172.4 IU/mL. There were no significant differences in initial beta-hCG values, gestational age between single-dose group and multiple-dose groups, The overall success rate of MTX management for an ectopic pregnancy was 82.5% (33/40) with 66.7% (12/18) and 95.5% (21/22) for single and multiple dose groups respectively. Multiple dose group had more rapid downward trend of hCG and more rapid stabilization. Side effects occurred in 20% (8/40) of the study group with 16.7% (3/18) and 22.7% (5/22) for single and multiple dose groups respectively but not significant.
CONCLUSION
Systemic single-dose and multiple-dose MTX regimen combined with local MTX injection with aspiration curettage and local MTX injection is an effective and safe treatment modality for cervical pregnancies. In our study, multiple-dose regimen treatment is more effective, mild side effects comparable with single dose regimen. Further comparative studies with long-term follow-up are needed to evaluate reproductive outcome and to reduce side effects.