ULTRASOUND-GUIDED INJECTION OF METHOTREXATE VERSUS LAPAROSCOPIC SALPINGOTOMY IN ECTOPIC PREGNANCY

Objective: To compare local injection of methotrexate (MTX) under sonographic control to laparoscopic salpingotomy for conservative management of ectopic pregnancy (EP). Design: Prospective randomized study. Patients: Forty patients were randomized into two groups using a random number table. Inclusion criteria were an EP visualized by ultrasound with a pretherapeutic score less than or equal to 13 as assessed by six criteria graded from 1 to 3: gestational age, hCG level, P level, abdominal pain, volume of the hemoperitoneum, and diameter of the hematosalpinx. Interventions: Group 1 patients injected transvaginally with 1 mg/kg MTX into the EP without anesthesia versus group 2 patients undergoing laparoscopic salpingotomy. Main Outcome Measures: Postoperative hospital stay, decrease of hCG levels, success rate. Results: The success rates, defined by hCG levels returned to normal (<10 mIU/mL [conversion factor to SI units, 1.00]), were 19 of 20 in both groups. Medical treatment was associated significantly with shorter postoperative stay (24 versus 46 hours) and a higher initial hCG level. Human chorionic gonadotropin returned to normal more quickly after laparoscopic treatment (14 versus 28 days). Conclusions: In selected cases of EP with a pretherapeutic score less than or equal to 13, MTX treatment appeared to be as safe and efficient as was conservative treatment by laparoscopy.