Skip to main content
SpringerLink
Log in

Single-dose methotrexate for the treatment of unruptured ectopic pregnancy

  • Original Article
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Objective

The objective of this study was to review our experience with single dose intramuscular methotrexate (MTX) for the treatment of ectopic pregnancy and to evaluate major confounding factors that relate to the success of therapy.

Patients and methods

The selection criteria were patients who had a stable hemodynamic status and an ectopic gestational mass of <4 cm. on ultrasound. Patients were not excluded from MTX therapy either by a baseline serum β-hCG titer or by the presence of fetal cardiac activity demonstrated on ultrasonography. Thirty- four of 86 patients diagnosed with ectopic pregnancy and treated with single-dose MTX between July 1999 and November 2001 were reviewed retrospectively.

Results

The mean pre-treatment β-hCG level was 2,490±2,912 mIU/ml. Twenty-two patients (73.3%) were successfully treated with a single-dose of MTX. Eight patients (26.6%) required a second dose 1 week after the first injection and 2 patients received three doses. Thirty of the 34 patients (88%) were successfully treated with MTX. The mean pre-treatment β-hCG level was significantly lower in patients who were successfully treated with MTX than in patients who failed MTX therapy (1,932±2,361 mIU/ml vs. 6,955±2,690 mIU/ml respectively, p<0.05). The mean pre-treatment serum β-hCG level was higher in patients who had a second MTX injection as compared to patients who were successfully treated with a single injection of MTX (3,272±3,551 mIU/ml vs. 1,280±2,273 mIU/ml respectively, p>0.05). The mean time to resolution of β-hCG was 26.5 days (10 to 37 days) with MTX. All 3 patients who failed medical therapy had β-hCG level >4,000 mIU/ml and 2 of them had positive fetal cardiac activity.

Conclusion

In conclusion, this study showed that medical treatment of ectopic pregnancy with systemic single-dose methotrexate seems to be an option for some patients with unruptured tubal pregnancy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Corsan GH, Karacan M, Qasim S, Bohrer MK, Ransom MX, Kemmann E (1995) Identification of hormonal parameters for successful systemic single-dose methotrexate therapy in ectopic pregnancy. Hum Reprod 10:2719–2722

    CAS  PubMed  Google Scholar 

  2. Fernandez H, Benifla JL, Leladier C, Baton C, Frydman R (1993) Methotrexate treatment of ectopic pregnancy: 100 cases treated by primary transvaginal injection under sonographic control. Fertil Steril 59:773–777

    CAS  PubMed  Google Scholar 

  3. Glock JL, Johnson JV, Brumsted JR (1994) Efficacy and safety of single dose systemic methotrexate in the treatment of ectopic pregnancy. Fertil Steril 62:716–721

    CAS  PubMed  Google Scholar 

  4. Hajenius PJ, Engelsbel S, Mol BW, Van der Veen F, Ankum WM, Bossuyt PM, Hemrika DJ, Lammes FB (1997) Randomised trial of systemic methotrexate versus laparoscopic salpingostomy in tubal pregnancy. Lancet 350:774–779

    CAS  PubMed  Google Scholar 

  5. Henry MA, Gentry WL (1994) Single injection of methotrexate for treatment of ectopic pregnancies. Am J Obstet Gynecol 171:1584–1587

    CAS  PubMed  Google Scholar 

  6. Lehner R, Kucera E, Jirecek S, Egarter C, Husslein P (2000) Ectopic pregnancy. Arch Gynecol Obstet 263:87–92

    CAS  PubMed  Google Scholar 

  7. Lipscomb GH, Bran D, McCord ML, Stovall TG, Portera JC, Ling FW (1998) Analysis of three hundred fifteen ectopic pregnancies treated with single-dose methotrexate. Am J Obstet Gynecol 178:1354–1358

    CAS  PubMed  Google Scholar 

  8. Lipscomb GH, McCord ML, Stovall TG, Huff G, Portera SG, Ling FW (1999) Predictors of success of methotrexate treatment in women with tubal ectopic pregnancies. N Engl J Med 341:1974–1978

    CAS  PubMed  Google Scholar 

  9. Mol BW, Hajenius PJ, Engelsbel S, Ankum WM, Van der Veen F, Hemrika DJ, Bossuyt PM (1998) Serum human chorionic gonadotropin measurement in the diagnosis of ectopic pregnancy when transvaginal sonography is inconclusive. Fertil Steril 70:972–981

    Article  CAS  PubMed  Google Scholar 

  10. Nieuwkerk PT, Hajenius PJ, Ankum WM, Van der Veen F, Wijker W, Bossuyt PM (1998) Systemic methotrexate therapy versus laparoscopic salpingostomy in patients with tubal pregnancy. I. Impact on patients' health-related quality of life. Fertil Steril 70:511–517

    Article  CAS  PubMed  Google Scholar 

  11. Ory SJ, Villanveua AL, Sand PK, Tamura RK (1986) Conservative treatment of ectopic pregnancy with methotrexate . Am J Obstet Gynecol 154:1299–1306

    CAS  PubMed  Google Scholar 

  12. Parker J, Bisits A, Proietto AM (1998) A systemic review of single-dose intramuscular methotrexate for the treatment of ectopic pregnancy. Aust NZ J Obstet Gynaecol 38:145–150

    CAS  Google Scholar 

  13. Sadan O, Ginath S, Debby A, Rothmensch S, Golan A, Zakut H, Glezerman M (2001) Methotrexate versus hyperosmolar glucose in the treatment of extrauterine pregnancy. Arch Gynecol Obstet 265:82–84

    Article  CAS  PubMed  Google Scholar 

  14. Saraj AJ, Wilcox JG, Najmadi S, Stein SM, Johnson MB, Paulson RJ (1998) Resolution of hormonal markers of ectopic gestation: a randomized trial comparing single-dose intramuscular methotrexate with salpingostomy. Obstet Gynecol 92:989–994

    Article  CAS  PubMed  Google Scholar 

  15. Sauer MV, Gorrill MJ, Rodi IA, Yeko TR, Greenberg LH, Bustillo M, Gunning JE, Buster JE (1987) Non-surgical management of unruptured ectopic pregnancy: an extended clinical trial. Fertil Steril 48:752–755

    CAS  PubMed  Google Scholar 

  16. Shalev E, Yarom I, Bustan M, Weiner E, Ben-Shlomo I (1998) Transvaginal sonography as the ultimate diagnostic tool for the management of ectopic pregnancy: experience with 840 cases. Fertil Steril 69:62–65

    Google Scholar 

  17. Sowter MC, Farquar CM, Petrie KJ, Gudex G (2001) A randomized trial comparing single dose systemic methotrexate and laparoscopic surgery for the treatment of unruptured tubal pregnancy. Br J Obstet Gynaecol 108:192–203

    Article  CAS  Google Scholar 

  18. Sowter MC, Farquar CM, Gudex G (2001) An economic evaluation of single dose systemic methotrexate and laparoscopic surgery for the treatment of unruptured tubal pregnancy. Br J Obstet Gynaecol 108:204–212

    Article  CAS  Google Scholar 

  19. Stika CS, Anderson L, Frederiksen MC (1996) Single-dose methotrexate for the treatment of ectopic pregnancy: Northwestern Memorial Hospital three-year experience. Am J Obstet Gynecol 174:1840–1848

    CAS  PubMed  Google Scholar 

  20. Stovall TG, Ling FW (1994) Single-dose methotrexate: an expanded clinical trial. Am J Obstet Gynecol 170:1840–1841

    PubMed  Google Scholar 

  21. Stovall TG, Ling FW, Gray LA (1991) Single-dose methotrexate for treatment of ectopic pregnancy. Obstet Gynecol 77:754–757

    CAS  PubMed  Google Scholar 

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

    Google Scholar 

  23. Tawfiq A, Agameya A, Claman P (2000) Predictors of treatment failure for ectopic pregnancy treated with single-dose methotrexate. Fertil Steril 74:877–880

    Article  CAS  PubMed  Google Scholar 

  24. Vermesh M, Silva PD, Rosen GF, Stein AL, Fossum GT, Sauer MV (1989) Management of unruptured ectopic gestation by linear salpingostomy: a prospective, randomized clinical trial of laparoscopy versus laparotomy. Obstet Gynecol 73:400–404

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Faculty of Medicine, Gazi University, Turkey

    Mehmet Erdem, Ahmet Erdem, Arzu Öç, Kutay Biberoğlu & Rifat Gürsoy

  2. Department of Obstetric and Gynecology, Faculty of Medicine, Isparta Süleyman Demirel University, Turkey

    Murat Arslan

  3. Bilkent III, Ufuk Sitesi, F3 Blok Daire 12, Bilkent, Ankara, Turkey

    Mehmet Erdem

Authors
  1. Mehmet Erdem
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ahmet Erdem
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Murat Arslan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Arzu Öç
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kutay Biberoğlu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Rifat Gürsoy
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mehmet Erdem.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Erdem, M., Erdem, A., Arslan, M. et al. Single-dose methotrexate for the treatment of unruptured ectopic pregnancy. Arch Gynecol Obstet 270, 201–204 (2004). https://doi.org/10.1007/s00404-003-0543-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-003-0543-4

Keywords

Search

Navigation