Life-threatening neutropenia following methotrexate treatment of ectopic pregnancy: A report of two cases

Abstract

To our knowledge, this is the first description of significant morbidity secondary to bone marrow suppression following methotrexate treatment of ectopic pregnancy. Most patients with ectopic pregnancy who are treated with methotrexate can expect resolution of their symptoms and a low risk of mild complications. However, serious complications after this therapy are possible and may occur even with the single-dose regimen.

Placenta accreta treated with planned caesarean hysterectomy

“…In addition, methotrexate exposes the patient to the risk of neutropenia or medullary aplasia; even with a single dose in a young patient for the treatment of ectopic pregnancy. 23 These types of side-effects can have a dramatic impact in a patient with an intrauterine placenta with a 30% risk of infectious complications. 19 Finally, the only case of maternal death after conservative treatment was secondary to a cascade of complications (bone marrow suppression, sepsis, renal failure) attributed to an intra-umbilical cord administration of methotrexate.…”

Persistent Ectopic Pregnancy After Laparoscopic Linear Salpingostomy for Tubal Pregnancy: Prevention and Early Detection

“…However, although generally mild, side effects related to systemic MTX administration have been reported in up to 24% of cases, 8 including some cases of serious side effects. 9 Therefore, the implementation of prophylactic systemic administration of MTX for all patients remains controversial. Importantly, local intratubal administration of MTX has been reported to enhance local anti-trophoblastic activity, 16 in addition to reducing side effects, 17,18 and may thus be a more effective and safer regimen for preventing PEP.…”

Clinical Treatment of Unruptured Ectopic Pregnancy

“…MTX is a safe treatment for an unruptured ectopic pregnancy. Life-threatening complications rarely have been reported with MTX (Isaacs et al, 1996). Approximately 40% of the patients feel pain between 3 and 7 days after MTX injection, but such pain normally resolves within 4 to 12 hours .…”