Treatment of tubal pregnancy by local injection of methotrexate after adrenaline injection into the mesosalpinx: a report of 25 patients

Predictors of success in methotrexate treatment of women with unruptured tubal pregnancies

“…For the first time, the present study shows two specific factors that play a role in and predict the success of this treatment: the hCG level, already recognized as an important predictor26, and the route of administration, with local treatment presenting a significant advantage. The great heterogeneity of the series published to date is largely attributable to the variety of protocols for MTX administration, namely IM injection1, 6, oral administration7 and local injection under laparoscopic8–10 or ultrasound guidance11, 13, 15. The principal indicator of success in these studies is the initial hCG level, but the great variation in inclusion criteria probably explains the variation in success rates, between 61%10 and 93%16 after one injection.…”

“…Since the first publication by Tanaka et al 1, many series have reported the results of conservative medical treatment with methotrexate (MTX) for EP. They have used various methods of administration: intramuscular (IM) or intravenous (IV) injection of one to four doses1–6, oral7 or local injection under laparoscopic8–10 or sonographic control11–15. We have previously reported MTX failure rates similar to those reported in conservative laparoscopic surgery when appropriate inclusion criteria were used13.…”

Ectopic Pregnancy

“…More promising than the systemic chemotherapy may be the local injection of methotrexate into the ectopic either under the direction of ultrasound or at the time of diagnosis at laparoscopy. In a recent study by Kooi and Kock, 57 the authors were successful in 17 of 24 patients with a single injection. Seven patients required additional systemic injections, and one patient experienced tubal rupture 3 days after the initial injection.…”

“…The use of methotrexate to abort an ectopic pregnancy has been advocated, especially in cases of cornual pregnancy, incomplete resolution of surgically treated ectopic gestation, residual trophoblastic tissue, in the poor risk patients with gonadotropin‐induced ovarian hyperstimulation syndrome, or in patients suspected of having extensive intraperitoneal abdominal adhesions 57 . In most of these cases, the surgical option is associated with greater risk of vascular and intestinal complications or greater trauma to the ovaries and tubes.…”

Advancing Conservative Treatment of Ectopic Pregnancy — Laparoscopic and “Non-Surgical” Management

“…(20) using doses from 5 to 25 mg and by Kooi and Kock(21) using 100 mg MTX after adrenaline injection into the mesosalpinx. Minimal side effects only appeared during supplementary systemic therapy.…”