Methotrexate for ectopic pregnancy: when and how
- 1.9k Downloads
Ectopic pregnancy is the leading cause of maternal death in the first trimester of pregnancy. The dosage of beta fraction of human chorionic gonadotropin (beta-hCG) and improvement of the transvaginal ultrasound allowed an earlier diagnosis and a conservative management. Currently, the use of systemic methotrexate (MTX) proved to be a great alternative with similar success rates and completely non-invasive.
We searched for the most relevant articles on the use of MTX in ectopic pregnancy published between 2003 and 2013 in high-impact journals. We performed a strategic search at the Centre for Reviews and Dissemination (CRD), Database of Abstracts of Reviews of Effects (DARE), National Institute for Health Research (NHS), International Prospective Register of Systematic Reviews (PROSPERO), The Cochrane Database of Systematic Reviews (CDSR) and Medical Literature Analysis and Retrieval System Online (MEDLINE) according to the descriptors “pregnancy, ectopic” and “methotrexate”, alone or combined.
Thus, we based this review on 32 studies that were classified following the grades of recommendation and levels of evidence proposed by the Oxford Centre for Evidence-Based Medicine. Additionally, selected papers were used. Scientific evidence points to a growing trend in the choice of conservative treatment for ectopic pregnancies, whereas expectant management still lacks studies for definitive conclusions. Indeed, the well-established protocols which exhibit a greater number of studies are still based on the single-dose treatment.
Considering MTX, it proved to be more effective in cases of low titers of beta-hCG and masses with a small diameter, although there is still no uniformity of these parameters. The choice largely depends on the experience of the medical team and ultimately, on the woman’s reproductive desire.
KeywordsEctopic pregnancy Methotrexate Therapeutic Reproductive health
Conflict of interest
- 4.Alleyassin A, Khademi A, Aghahosseini M, Safdarian L, Badenoosh B, Hamed EA (2006) Comparison of success rates in the medical management of ectopic pregnancy with single-dose and multiple-dose administration of methotrexate: a prospective, randomized clinical trial. Fertil Steril 85:1661–1666PubMedCrossRefGoogle Scholar
- 8.Hajenius PJ, Mol F, Mol BWJ, Bossuyt PM, Ankum WM, van der Veen F (2009) Interventions for tubal ectopic pregnancy. Cochrane Database Syst Rev (1):CD000324.Google Scholar
- 11.American College of Obstetricians and Gynecologists (2008) ACOG Practice Bulletin No. 94: Medical management of ectopic pregnancy. Obstet Gynecol 111:1479–1485 (can not apply oxford classification)Google Scholar
- 12.Barnhart KT (2009) Ectopic Pregnancy. N Engl J Med 361:379–387 (can not apply oxford classification)Google Scholar
- 35.OCEBM Levels of Evidence Working Group: “The Oxford 2011 Levels of Evidence”. http://www.cebm.net/index.aspx?o=5653. Accessed 16 Sept 2013
- 37.Jurkovic D (2012) Randomised double blind controlled trial of single dose methotrexate versus expectant management in women with tubal ectopic pregnancy. http://www.controlled-trials.com/ISRCTN95698259. Accessed 16 Sept 2013
- 39.American Society for Reproductive Medicine (2013) Medical treatment of ectopic pregnancy: a committee opinion. Fertil Steril 100:638–644. (can not apply oxford classification)Google Scholar
- 45.Júnior EJ, Musiello RB, Júnior EA, Souza E, Fava JL, Guerzet EA, Camano L (2013) Conservative management of cervical pregnancy with embryonic heart activity by ultrasound-guided local injection: an eight case series. J Matern Fetal Neonatal Med. doi: 10.3109/14767058.2013.856413