Single-dose versus two-dose administration of methotrexate for the treatment of ectopic pregnancy: a randomized controlled trial

Song, Taejong; Kim, Mi Kyoung; Jung, Yong Wook; Yun, Bo Hyon; Seong, Seok Ju

doi:10.1093/humrep/dev312

Cited by 28 publications

(60 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…7 Two of these studies also find a reduced time to resolution with the 2-dose protocol. 7,8 Overall our finding of similar success rates and time to resolution for the 2 protocols, despite confounding by indication, is consistent with the results of these randomized trials 7–9 and supports the use of the 2-dose protocol as primary medical management of ectopic pregnancy.…”

Section: Commentsupporting

confidence: 85%

Medical management of ectopic pregnancy with single-dose and 2-dose methotrexate protocols: human chorionic gonadotropin trends and patient outcomes

Mergenthal

Senapati

Zee

et al. 2016

American Journal of Obstetrics and Gynecology

View full text Add to dashboard Cite

BACKGROUND Ectopic pregnancy, although rare, is an important cause of female morbidity and mortality and early, effective treatment is critical. Systemic methotrexate has become widely accepted as a safe and effective alternative to surgery in the stable patient. As the number and timing of methotrexate doses differ in the 3 main medical treatment regimens, one might expect trends in serum human chorionic gonadotropin and time to resolution to vary depending on protocol. Furthermore, human chorionic gonadotropin trends and time to resolution may predict ultimate treatment success. OBJECTIVE This study hypothesized that the 2-dose methotrexate protocol would be associated with a faster initial decline in serum human chorionic gonadotropin levels and a shorter time to resolution compared to the single-dose protocol. STUDY DESIGN A prospective multicenter cohort study included clinical data from women who received medical management for ectopic pregnancy. Rates of human chorionic gonadotropin change and successful pregnancy resolution were assessed. Propensity score modeling addressed confounding by indication, the potential for differential assignment of patients with better prognosis to the single-dose methotrexate protocol. RESULTS In all, 162 ectopic pregnancies were in the final analysis; 114 (70%) were treated with the single-dose methotrexate and 48 (30%) with the 2-dose protocol. Site, race, ethnicity, and reported pain level were associated with differential protocol allocation (P < .001, P = .011, P < .001, and P = .035, respectively). Women had similar initial human chorionic gonadotropin levels in either protocol but the mean rate of decline of human chorionic gonadotropin from day 0 (day of administration of first dose of methotrexate) to day 7 was significantly more rapid in women who received the single-dose protocol compared to those treated with the 2-dose protocol (mean change −31.3% vs −10.4%, P = .037, adjusted for propensity score and site). The 2 protocols had no significant differences in success rate or time to resolution. CONCLUSION In a racially and geographically diverse group of women, the single- and double-dose methotrexate protocols had comparable outcomes. The more rapid human chorionic gonadotropin initial decline in the single-dose group suggested these patients were probably at lower risk for ectopic rupture than those getting the 2-dose protocol. A prospective randomized controlled design is needed to remove confounding by indication.

show abstract

Section: Commentsupporting

confidence: 85%

Medical management of ectopic pregnancy with single-dose and 2-dose methotrexate protocols: human chorionic gonadotropin trends and patient outcomes

Mergenthal

Senapati

Zee

et al. 2016

American Journal of Obstetrics and Gynecology

View full text Add to dashboard Cite

show abstract

“…The results remained similar after exclusion of the study by Hamed et al . (RR 0.51, 95% CI 0.40–0.85; three trials, 282 patients, I 2 =0%).…”

Section: Resultssupporting

confidence: 57%

“…). However, in a subgroup analysis including tubal pregnancies only, the SDP appeared to result in fewer adverse effects than the non‐SDPs (RR 0.67, 95% CI 0.49–0.90; four trials, 439 patients, I 2 =0%). The results remained similar after exclusion of the study by Hamed et al .…”

Section: Resultsmentioning

confidence: 92%

“…However, in a subgroup analysis including tubal pregnancies only, the time to resolution was longer for the SDP than for the non‐SDPs (MD 7.01 days, 95% CI 2.76–11.26 days; three trials, 369 patients, I 2 =75%). After exclusion of the study by Hamed et al., the results remained similar (MD 4.79 days, 95% CI 2.11–7.46 days; two trials, 212 patients, I 2 =0%).…”

Section: Resultsmentioning

confidence: 93%

See 1 more Smart Citation

Systematic review and meta‐analysis of single‐dose and non‐single‐dose methotrexate protocols in the treatment of ectopic pregnancy

Yuk

Lee

Park

et al. 2018

Intl J Gynecology & Obste

View full text Add to dashboard Cite

show abstract

“…The choices of treatment for ectopic pregnancy are expectant treatment (close monitoring) (10), drug therapy (11) and surgery (1). Interventional treatment is another alternative for ectopic uterine and extra-uterine pregnancies, although non-tubal ectopic pregnancy, particularly that which is cervical, abdominal, ovarian or in a cesarean scar, represents a major clinical challenge (12).…”

Section: Introductionmentioning

confidence: 99%

Ectopic pregnancy in the liver incidentally diagnosed by imaging: A case report

Cai

Xiao

Shang

et al. 2017

Experimental and Therapeutic Medicine

View full text Add to dashboard Cite

Abstract. The present report describes the case of a 31-year-old woman diagnosed with an ectopic pregnancy in the liver. The patient presented with amenorrhea for 40 days and abdominal distention for 27 days. A liver mass had been detected 6 days prior to presentation. Using ultrasound (US), a hyperechoic mass with a fluid sonolucent area was detected in the right hepatic lobe. Examination by computed tomography (CT) revealed the presence of a mass in the right hepatic lobe with a slightly low-density peripheral region and an oval central portion of lower density in the plain scan; the enhanced scan revealed a significantly enhanced peripheral region and a non-enhanced central portion.18 F-fluodeoxyglucose (FDG) positron emission tomography (PET)-CT showed a mass in the right hepatic lobe with an increased intake of FDG in the peripheral region (maximum standard uptake value, 5.7) and a non-increased intake of FDG in the central portion. The patient was then subjected to hysteroscopy and laparoscopy. Histopathologically, the mass was an ectopic pregnancy. The patient recovered following the surgery. In conclusion, a timely diagnosis of ectopic pregnancy was made for a 31-year-old women with an ectopic pregnancy in the liver on the basis of US, CT and PET-CT imaging results, which enabled surgery to be undertaken prior to any serious consequences. These observations may be helpful for the diagnosis of similar cases in the future.

show abstract

Single-dose versus two-dose administration of methotrexate for the treatment of ectopic pregnancy: a randomized controlled trial

Abstract: 26 May 2013.

Cited by 28 publications

References 16 publications

Medical management of ectopic pregnancy with single-dose and 2-dose methotrexate protocols: human chorionic gonadotropin trends and patient outcomes

Medical management of ectopic pregnancy with single-dose and 2-dose methotrexate protocols: human chorionic gonadotropin trends and patient outcomes

Systematic review and meta‐analysis of single‐dose and non‐single‐dose methotrexate protocols in the treatment of ectopic pregnancy

Ectopic pregnancy in the liver incidentally diagnosed by imaging: A case report

Contact Info

Product

Resources

About