Medical treatment of ectopic pregnancy with methotrexate

Objective: To review our experience with low-dose IM methotrexate for the medical management of ectopic pregnancy (EP). Design: Retrospective chart review. Setting: Magee-Womens Hospital, Pittsburgh, Pennsylvania. Patient(s): The first 50 women treated by the resident service in whom EP was diagnosed and treated with methotrexate. Intervention(s): Intramuscular methotrexate 50 mg/m(2). Serum beta-hCG was evaluated 4 and 7 days after treatment and then weekly thereafter. The dose was repeated if the beta-hCG level did not drop greater than or equal to 15% between days 4 and 7 or if a plateau or rise was noted during weekly followup evaluation. Surgery was performed if significant abdominal pain occurred in the presence of hemodynamic instability or signs of peritoneal irritation on physical examination. Main Outcome Measure(s): Resolution of the EP without surgical intervention. Result(s): Two patients were lost to follow-up and one was treated without a certain diagnosis of EP. Forty-three of the remaining 47 women (91.5%; 95% confidence interval, 83.5%, 99.5%) were treated successfully with methotrexate. Of these, 36 women were treated with a single dose, and 7 required a second dose. Four women were treated surgically after medical management failed. The time from initiation of treatment to cure in women who were treated successfully was 25 +/- 15 days (mean +/- SD). Thirteen patients (27.7%) made additional visits to the emergency department because of increased abdominal pain. Conclusion(s): As medical therapy for EP becomes common practice, familiarity with its side effects may lead to greater success rates. The decision to abandon medical treatment and proceed with surgery should be based on defined guidelines, such as the development of peritoneal signs, decreasing hemoglobin levels, or hemodynamic instability. (C) 1997 by American Society for Reproductive Medicine.