Local Application of Methotrexate for Ectopic Pregnancy with a Percutaneous Puncturing Technique

Abstract

Management of ectopic pregnancy remains traditionally surgical. Early detection of unruptured ectopic pregnancies, using both ultrasound techniques and β-human chorionic gonadotropin (β-hCG) assays, allows a more conservative treatment. Twenty-six tubal pregnancies, which were managed with local methotrexate (MTX) injection, are presented. A single dose of 10–12.5 mg of MTX was percutaneously injected into the gestational sac under abdominal sonographic control. Complete resolution was obtained in all our patients. Four of them required a second percutaneous administration 4 days after the first one. Negligible serum β-hCG levels (<10 mIU/ml) were reached within 42 days after treatment. No systemic side effects were observed. Local administration of MTX under abdominal sonographic control seems to be an effective alternative for the treatment of ectopic pregnancy. The main potential advantages of the method are (1) a greater antitrophoblastic effect; (2) a shorter treatment period; (3) reduced dosage, and (4) absence of side effects.

Management of Ovarian Cysts with Aspiration and Methotrexate Injection

“…The absence of side effects is probably due to this reduced dose. In several studies of local methotrexate administration in ectopic pregnancies, no side effects were observed (43,44).…”

Local Treatment of Ectopic Pregnancy

“…18 Although TVUS guidance has many advantages, including a fixed needle guide and greater familiarity with many surgeons, abdominal US guidance has been used successfully with free-hand placement of a spinal needle and no local or general anesthesia. 19 As with many surgical procedures, this may reflect more about the surgeon than the instrumentation.…”

Protective effect of calcium folinate against methotrexate-induced endosalpinx damage in rats

“…Methotrexate (MTX) is a classical folate antagonist that has been used in the treatment of ectopic pregnancy (EP) for many years (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16). Patients with EP can be successfully treated with MTX in various protocols and approaches (1)(2)(3)(5)(6)(7)(8)(9)(10).…”

“…Patients with EP can be successfully treated with MTX in various protocols and approaches (1)(2)(3)(5)(6)(7)(8)(9)(10). However, laboratory evidence suggests that MTX can induce toxicity in the endosalpinx (17)(18)(19).…”

“…Antifolate substances, represented by MTX, continue to occupy a unique and important niche among modern pharmacopoeia for patients with EP (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16). MTX can inhibit normal trophoblasts and decrease cytotrophoblast differentiation and proliferation (4,30), and it can be used to treat EP effectively (1-3, 5-10).…”