Treatment of ectopic pregnancy with methotrexate (original) (raw)
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Zagazig University Medical Journal, 2020
Background: Using Methotrexate as an option for medical treatment of ectopic pregnancies has been suggested since 1982. Studies regarding the dose, number of doses of methotrexate and the predictive factors of degree of success of methotrexate in the medical management of ectopic pregnancy are limited. Aim of the present article were; to assess the predictive factors of success and efficacy of methotrexate therapy and to assess the value and efficacy of using lower dose of methotrexate and the suitable number of doses for medical management of ectopic pregnancy. Methods: we included 100 patients with ectopic tubal pregnancy that were given Methotrexate dosage 1 mg/kg which was injected intramuscular. After the first injection we asked the patients to return on the 4 th day then on the 7 th day to test the levels of hCG. In case of reduction of the level of β-hCG less than 15% on 4 th and 7 th days, patients were given the second methotrexate dose of 1 mg/kg which was also injected intramuscular. We followed patients until achieving β-hCG target level (<15 mIU/mL) then completely negative values. We assessed rates and predictive factors for success or failure of methotrexate therapy. Results: of the included 100 patients, 15 patients needed surgical management at the end of treatment, with a success rate of medical Methotrexate therapy of 85%.The pretreatment predictive factors of failure of medical treatment are; presence of a pretreatment adnexal mass (p= 0.040), presence of pain (p= 0.039), metrorrhagia (p= 0.023), or hemoperitoneum (p= 0.002). Base line pretreatment hCG levels was the most important predictive factor of therapy success (p= 0.002). Conclusions: methotrexate in a single dose or two doses could effectively treat ectopic pregnancy with fewer side effects providing that base line hCG level < 5000 IU/L in hemodynamically stable young patients with no liver or kidney problems with a higher success rate.
Journal of Obstetrics & Gynaecology, 2011
The purpose of this study was to compare the safety and success rates of single-and two-dose methotrexate (MTX) protocols for the treatment of unruptured tubal ectopic pregnancy. This retrospective study included 87 patients with ectopic pregnancy who were treated with MTX therapy (single-dose protocol: 46 patients; two-dose protocol: 41 patients). Both protocol groups were compared with regard to success rates, b-hCG and progesterone levels, the presence of cardiac activity, a history of previous ectopic pregnancy, ectopic mass size, gestational age, adverse events, and number of repeat MTX doses. Success rates between the single-dose and two-dose methotrexate therapy groups were comparable (87% vs 90.2%; OR 0.7, 95% CI 0.18-2.75; p ¼ 0.74). No significant differences were found between the groups in factors influencing MTX treatment success rate, including the mean b-hCG level, mean progesterone level, the presence of a positive cardiac activity, mean ectopic mass size, mean endometrial thickness, and the presence of a yolk sac. There were also no significant between-group difference were found in the percentage of women who needed a repeat dose of MTX (17.3% vs 7.3%; OR 0.3, 95% CI 0.09-1.52; p ¼ 0.20) and in the percentage of adverse events (45.7% vs 58.7%; OR 1.6, 95% CI 0.71-3.93; p ¼ 0.28). In conclusion, medical treatment with single-dose or with twodose systemic MTX seem to be equal therapeutic options for patients with unruptured ectopic pregnancy. J Obstet Gynaecol Downloaded from informahealthcare.com by 88.229.205.34 on 05/02/11 For personal use only. Comparison of single-dose and two-dose methotrexate protocols 333 J Obstet Gynaecol Downloaded from informahealthcare.com by 88.229.205.34 on 05/02/11
American Journal of Obstetrics and Gynecology, 2005
The purpose of this study was to compare success rates of 643 patients who had ectopic pregnancy from the same database who were treated with multidose or single-dose methotrexate protocols. Study design: We compared demographics, gestational age, serum human chorionic gonadotropin, progesterone levels, ectopic sac size and volume, overall ectopic mass size and volume, ectopic cardiac activity, history of ectopic pregnancy, number of treatment days, methotrexate doses, and outcome in consecutive patients with ectopic pregnancy who were treated with methotrexate. Results: Success rates were comparable between patients with multidose and single-dose therapy (95% vs 90%, respectively) as were human chorionic gonadotropin and progesterone levels, history of ectopic pregnancy (21.4% vs 21.7%, respectively), number of treatment days, gestational age, ectopic size, ectopic volume, and ectopic mass volume. Patients who received single-dose therapy were significantly heavier (146 vs 159 pounds), had greater ectopic cardiac activity (3.1% vs 10.3%), and received fewer methotrexate doses. Conclusion: This study suggests single-dose methotrexate therapy is as effective as multidose methotrexate therapy for the treatment of ectopic pregnancy.
Journal of Obstetrics and Gynaecology Research, 2020
Aim: Methotrexate (MTX) treatment at a dose of 50 mg/m 2 of body surface area (BSA) is an effective and widely used treatment method in ectopic pregnancy. However, there is a limited number of studies investigating lower MTX doses. In this study, we aimed to investigate the efficacy of lower MTX doses in the treatment of ectopic pregnancy. Methods: This retrospective study included a total of 112 patients who were hospitalized due to ectopic pregnancy and administered single-dose MTX. The patients were divided into three groups according to the dose given as 22-40 mg/m 2 of BSA (n = 17), 41-49 mg/m 2 of BSA (n = 81) and ≥ 50 mg/m 2 of BSA (n = 14). Data including demographic characteristics of the patients, previous history of ectopic pregnancy, previous gynecological surgeries, the use of in vitro fertilization techniques, ultrasonographic findings, beta-human chorionic gonadotropin hormone (β-hCG) levels, pre-treatment endometrial sampling, MTX doses applied, and the need for a surgical intervention during follow-up were retrieved from the hospital records. Results: Of the patients, 16.96% (n = 19) were operated at the end of treatment, irrespective of the pretreatment β-hCG levels with a success rate of 83% (n = 93). Fourteen (12.5%) of the patients received the second dose of MTX. The overall success rate was 89.2% in patients with a β-hCG level of ≤5000 mIU/mL. Conclusion: This study shows that lower MTX doses than 50 mg/m 2 , which has been considered standard treatment and widely used in the treatment of ectopic pregnancy for nearly three decades, are effective with similar success rates.
International Journal of Women's Health
Objective: To study factors associated with the success of single dose methotrexate (MTX) treatment in women with ectopic pregnancy. Methods: This is a retrospective study of women (n=110) with ectopic pregnancy and treated with single dose of MTX. The clinical presentations, transvaginal sonography (TVS) findings, pretreatment beta-human chorionic gonadotropin (β-HCG), and progesterone values were compared between the treatment success (Group S) and treatment failure (Group F) groups. Results: The overall success rate of treatment with single dose of MTX was 75.45%. The majority of patients in both groups presented with pain and bleeding (~55%), and bleeding only was the presenting symptom in about 20% of patients. Only 3 patients (3.61%) in Group S required a repeat dose of MTX. In contrast, 51.8% of the Group F patients required a repeat dose. The mean pretreatment β-HCG level was 2.3 times higher in Group F than in Group S (1734±1684 vs 4036±2940 IU/L). The data showed a β-HCG level of 3924IU/L as a suitable cutoff value with 76.19% sensitivity and 62.5% specificity to predict MTX treatment success. History of ectopic pregnancy had no relation with success/treatment failure or a repeat dose. None of the TVS findings were related to the outcome of the treatment, whereas pretreatment HCG level was a significant predictor. Conclusion: The single dose MTX treatment was successful in 75.45% (83/110) of cases, with 3.61% (3/83) requiring a repeat dose of the drug. Pretreatment β-HCG level is a significant predictor of the treatment outcome.
Background: Medical treatment of ectopic pregnancy with methotrexate has been considered as an alternative to surgical intervention. Aims and objectives: The present was carried with an aim to determine the role of methotrexate in management of ectopic pregnancy. Materials and methods: The present study was carried out for a period of 5 years (September 2007 to August 2012) in a tertiary care hospital. It included a total of 128 patients of unruptured ectopic pregnancies. The medical management was done with methotrexate. Time taken for complete β human chorionic gonadotrophin (β hCG) resolution was recorded. The negative β hCG result indicated as an endpoint of successful outcome. Results: Out of 128 cases where Methotrexate was used, 4 required surgery. In remaining 124 cases, there were no side effects. Complete β hCG resolution was achieved in 28 -35 days. Subsequent tubal patency & reproductive functions were comparable to that of surgical management. Conclusion: From our study, it can be concluded that methotrexate can be recommended as safe and effective drug for management of unruptured ectopic pregnancies.
Medical Management of Ectopic Pregnancy using Methotrexate
The Internet Journal of Gynecology and Obstetrics, 2007
Background: Medical treatment of the ectopic pregnancy with methotrexate has been considered an alternative to surgical intervention. Aims & Objectives: 1) To review adherence to guidelines for the medical management of ectopic pregnancy 2) To determine: a) diagnostic investigations. b) Suitability for Methotrexate treatment c) Initial investigations 3) To ascertain: a) follow-up investigations b) outcome Methods:A retrospective study from January 2002-May 2006 was carried out, collecting clinical imaging data and serum betahuman chorionic gonadotrophin (βhCG). Time taken for complete βhCG resolution was recorded, and a negative βhCG result was used as an endpoint of successful outcome. Results: Of the 17 cases, where Methotrexate (50mg I.M) was used, three required surgery for symptoms of rupture. In the remaining 14 cases, there were no side-effects, complete βhCG resolution was achieved in 13 of the 14 medically treated cases (91% success rate), with in 28 days. Conclusion: Methotrexate used as treatment is safe and effective for unruptured ectopic pregnancies that satisfy the strict criteria with no side-effects and the advantage of avoiding invasive surgery. Subsequent tubal patency and reproductive functions were comparable to the surgery.
Study on the Effectiveness of Single Dose Methotrexate Therapy in Unruptured Ectopic Pregnancy
Journal of Evidence Based Medicine and Healthcare
BACKGROUND Ectopic gestation though potentially life threating, timely diagnosis and appropriate treatment can reduce the risk of maternal mortality and morbidity. The benefits of medical therapy particularly with single dose methotrexate and the cure rate are high. The objective of the study was to explore the efficiency of medical management with single-dose methotrexate in unruptured ectopic gestation. MATERIALS AND METHODS Women with an ectopic pregnancy, meeting the criteria for medical treatment were included in the study. All the patients were hospitalized. The protocol was a single dose of methotrexate 50mg IM or 1 mg/kg body weight. All the patients were reviewed after 4 days. If the beta-HCG level drops by 15%, then the women were reviewed weekly until the HCG level falls to less than 5 IU/L. The 2 nd dose was given if the HCG falls below 15% or if there is no drop. RESULTS The overall success rate of single-dose methotrexate was 64%. 2 nd dose methotrexate was required in 11% of patients. In 25% of the cases, surgery was required. Laparoscopic procedure was done in 12% of cases and emergency laparotomy was performed in 13% of the cases. CONCLUSION Single-dose methotrexate therapy is effective in a selected group of patients.
Double versus Single Dose Methotrexate Regimens in Management of Undisturbed Ectopic Pregnancy
Critical Care Obstetrics and Gynecology, 2016
Objective: To assess the effectiveness and safety of doubledose methotrexate in comparing to single-dose methotrexate for management of ectopic pregnancy. Methods: A prospective randomized-controlled trial was conducted on 200 patients with ectopic pregnancy at the Obstetrics and gynecological Departments of Zagazig University, Egypt between June, 2011 to May 2014. Patients were randomized into two groups, (group 1) who received a single dose 50 mg per meters squared surface area methotraxate (50 mg/m 2 IM on day 1) intramuscularly or (group 2), who received double-dose methotrexate regimen (50 mg/m2 intramuscularly on days 0 and 4). The outcomes were; success rate, time duration of fall down of b-hcg to <15 mlU/mL and undesirable effects of methotrexate. Results: In general, there is significant differences between both groups as regard the success rate and the duration of fall down β-hCG. The success rate was better in group 2 than in group 1 (90% versus 78.75%, P=0.01). The duration of fall down β-hCG until <15 mlU/mL was shorter in group 2 (P=0.01). There was no significant difference between groups in adverse effects. Conclusion: Double-dose methotrexate as one of regimens of medical management of undisturbed ectopic pregnancy had more effectiveness and success rate than that of singledose regimen with equivalent safety.
Single-dose methotrexate for ectopic pregnancy treatment: preliminary data
Acta bio-medica: Atenei Parmensis
Background and aim of the work: our purpose was to evaluate the efficacy of a single-dose of MTX for ectopic pregnancy treatment in a sample of patients carefully selected according to strict inclusion criteria. Methods: 11 patients that matched the inclusion criteria were enrolled. Results: β-hCG at diagnosis averaged 1349 mIU/ml out of the 11 treated patients, 10 (90%) received a single dose of MTX and had a time of EP resolution averaging 27,3 days. The remaining patient received an additional dose of MTX, equal to the start dose, with a time resolution of 35 days. Conclusions: This study provides evidence of the efficacy of MTX in EP treatment, both as therapy and as a form of clinical management: the successful medical management of EP, defined as β-hCG levels becoming negative after administration of one or more MTX doses, was obtained in all treated cases.