Combined local and systemic methotrexate treatment of viable ectopic pregnancy: Outcomes of 31 cases

Abstract

Combined MTX administration is effective and safe for treating viable cesarean scar pregnancies but is less successful for viable tubal or interstitial pregnancies. Reproductive outcomes following the combined MTX treatment are comparable to other treatment modalities for ectopic pregnancy.

Local Methotrexate Injection as the First-line Treatment for Cesarean Scar Pregnancy: Review of the Literature

“…12 000 IU/L in which systemic methotrexate might not be applicable. Therefore, to improve treatment outcomes some authors combined the use of both local and systemic methotrexate and reported high success rates [26,27]. Whether this combined modality is a better treatment option than single therapy is outside the scope of this review and remains to be studied.…”

Therapeutic options of caesarean scar pregnancy: Case series and literature review

“…Lai et al 21 (Table 2). Smorgick et al 23 evaluated combined local and systemic methotrexate treatment in 31 patients with a viable ectopic pregnancy, which was successful in all CSP cases (n 5 5). Although a 2 nd dose was required in 4 of 5 cases of CSP, surgical intervention could be avoided.…”

Sonographic diagnosis and successful medical management of an intramural ectopic pregnancy

“…The authors concluded that although this method was safe for cesarean scar pregnancies, it was less successful for tubal and interstitial pregnancies. 18 Other treatment options reported include expectant management of a 6-week intramural pregnancy 2 and intrafetal potassium chloride injected transcervically with abdominal sonographic guidance.…”

“…14,16 Although systemic methotrexate treatment and surgery are accepted modalities for tubal pregnancies, they are less effective for intramural pregnancies. 18 Sonographic-guided local methotrexate injections into gestational sacs of intramural pregnancies have been suggested. Smorgick et al evaluated the outcomes of combined local and systemic methotrexate treatment of unruptured viable ectopic pregnancies.…”