Obstet Gynecol Sci.  2017 Nov;60(6):571-578. 10.5468/ogs.2017.60.6.571.

Therapeutic outcomes of methotrexate injection in unruptured interstitial pregnancy

• Kim MJ
• Cha JH
• Bae HS
• Kim MK
• Kim ML
• Yun BS
• Kim YS
• Seong SJ
• Jung YW

• KMID: 2418359
• DOI: http://doi.org/10.5468/ogs.2017.60.6.571

Abstract

OBJECTIVE
To examine the therapeutic outcomes of methotrexate (MTX) in the treatment of unruptured interstitial pregnancy.
METHODS
We reviewed the medical records of patients who were diagnosed with interstitial pregnancy and received MTX as first-line treatment between January 2003 and July 2014 at CHA Gangnam Medical Center. The treatment success rates and subsequent pregnancy outcomes were examined.
RESULTS
Ninety-seven patients were diagnosed with interstitial pregnancy between January 2003 and July 2014. Of them, 38 initially received MTX treatment. The diagnosis was made at a median of 6+3 weeks (5+0 to 11+3 weeks). Thirty patients received a systemic MTX injection, while the other 8 received a local MTX injection. Systemic treatment composed of an 8-day alternating MTX regimen, single-dose regimen, or high-dose regimen (100 mg/m2 + 200 mg/m2 intravenously over 12 hours). The local injection consisted of a direct MTX injection into the gestational sac with or without systemic MTX injection. Twenty-one patients (55.3%) were successfully treated with MTX. However, MTX therapy failed in 17 patients (44.7%), who required surgery. Mode of MTX treatment was the only predictive variable of MTX treatment success (P=0.039). Treatment success was seen in 7 of 8 patients (87.5%) in the local MTX group vs. 14 of 30 patients (46.7%) in the systemic MTX group. After treatment, 13 patients attempted a successive pregnancy; of them, 10 patients had a confirmed clinical pregnancy and healthy live birth.
CONCLUSION
Combined MTX treatment including a local injection might be an initial approach to the treatment of interstitial pregnancy.

Keyword

Pregnancy, interstitial; Pregnancy complications; Conservative treatment; Methotrexate; Pregnancy outcome

MeSH Terms

Diagnosis
Female
Gestational Sac
Humans
Live Birth
Medical Records
Methotrexate*
Pregnancy
Pregnancy Complications
Pregnancy Outcome
Pregnancy, Interstitial*
Methotrexate

Reference

1. Faraj R, Steel M. Management of cornual (interstitial) pregnancy. Obstet Gynecol. 2007; 9:249–255.

2. Surbone A, Cottier O, Vial Y, Francini K, Hohlfeld P, Achtari C. Interstitial pregnancies' diagnosis and management: an eleven cases series. Swiss Med Wkly. 2013; 143:w13736.

3. Marion LL, Meeks GR. Ectopic pregnancy: history, incidence, epidemiology, and risk factors. Clin Obstet Gynecol. 2012; 55:376–386.

4. Lau S, Tulandi T. Conservative medical and surgical management of interstitial ectopic pregnancy. Fertil Steril. 1999; 72:207–215.

5. Takeda A, Koyama K, Imoto S, Mori M, Sakai K, Nakamura H. Successful management of interstitial pregnancy with fetal cardiac activity by laparoscopic-assisted cornual resection with preoperative transcatheter uterine artery embolization. Arch Gynecol Obstet. 2009; 280:305–308.

6. Tulandi T, Al-Jaroudi D. Interstitial pregnancy: results generated from the Society of Reproductive Surgeons Registry. Obstet Gynecol. 2004; 103:47–50.

7. Sagiv R, Debby A, Keidar R, Kerner R, Golan A. Interstitial pregnancy management and subsequent pregnancy outcome. Acta Obstet Gynecol Scand. 2013; 92:1327–1330.

8. Hajenius PJ, Voigt RR, Engelsbel S, Mol BW, Hemrika DJ, Van der Veen F. Serum human chorionic gonadotropin clearance curves in patients with interstitial pregnancy treated with systemic methotrexate. Fertil Steril. 1996; 66:723–728.

9. Borgatta L, Burnhill M, Stubblefield P. Single dose methotrexate therapy: application to interstitial ectopic pregnancy. Int J Gynaecol Obstet. 1998; 60:279–282.

10. Talmon R, Filmar S, Itskovitz-Eldor J. Successful treatment of cornual pregnancy with 1-day high-dose methotrexate regimen and folinic acid rescue. Gynecol Obstet Invest. 1993; 35:243–244.

11. Benifla JL, Fernandez H, Sebban E, Darai E, Frydman R, Madelenat P. Alternative to surgery of treatment of unruptured interstitial pregnancy: 15 cases of medical treatment. Eur J Obstet Gynecol Reprod Biol. 1996; 70:151–156.

12. Tanaka T, Hayashi H, Kutsuzawa T, Fujimoto S, Ichinoe K. Treatment of interstitial ectopic pregnancy with methotrexate: report of a successful case. Fertil Steril. 1982; 37:851–852.

13. Hiersch L, Krissi H, Ashwal E, From A, Wiznitzer A, Peled Y. Effectiveness of medical treatment with methotrexate for interstitial pregnancy. Aust N Z J Obstet Gynaecol. 2014; 54:576–580.

14. Tanaka K, Baartz D, Khoo SK. Management of interstitial ectopic pregnancy with intravenous methotrexate: an extended study of a standardised regimen. Aust N Z J Obstet Gynaecol. 2015; 55:176–180.

15. Jermy K, Thomas J, Doo A, Bourne T. The conservative management of interstitial pregnancy. BJOG. 2004; 111:1283–1288.

16. Hafner T, Aslam N, Ross JA, Zosmer N, Jurkovic D. The effectiveness of non-surgical management of early interstitial pregnancy: a report of ten cases and review of the literature. Ultrasound Obstet Gynecol. 1999; 13:131–136.

17. Timor-Tritsch IE, Monteagudo A, Lerner JP. ‘potentially safer’ route for puncture and injection of cornual ectopic pregnancies. Ultrasound Obstet Gynecol. 1996; 7:353–355.

18. Downey GP, Tuck SM. Spontaneous uterine rupture during subsequent pregnancy following non-excision of an interstitial ectopic gestation. Br J Obstet Gynaecol. 1994; 101:162–163.