Unruptured Tubal Pregnancy: Local Low-Dose Therapy with Methotrexate under Transvaginal Ultrasonographic Guidance

Abstract

Thirty patients with unruptured ectopic pregnancy (4–10 weeks’ gestation) were treated locally with methotrexate (MTX) under sonographic guidance. The transvaginal puncture was performed under analgesic sedation using an automatic puncturing device. Local MTX therapy was successful in 25 patients (83.3%). Eighteen of these patients had received a single MTX instillation with a total dose of 10 mg, 7 patients had received a second instillation with 10 mg because of plateauing hCG levels after the first instillation. In 5 patients MTX therapy was unsuccessful. Surgical intervention was necessary within 4 h to 15 days after MTX treatment, due to severe tubal bleeding (n = 1) or the development of an increasing peritubal hematoma (n = 4). Patients with an outer trophoblast diameter < 1.5 cm could be treated successfully in all cases (25/25). In patients with hCG values > 5,000 mlU/ml the success rate was 70% (7/10) and in patients with demonstration of cardiac activity of the embryo 63% (5/8). The fluid aspirated from the ectopic cavity showed an average hCG concentration that was 53 times higher than in the serum. The decline in hCG to values below 10mlU/ml ranged between 7 and 75 days (mean 28 days). The hysterosalpingography performed 4–6 months after MTX therapy showed tubal patency on both sides in 85.7% of the patients examined. In the meantime 4 of these patients gave birth to healthy children.

The efficacy and safety of managing ectopic pregnancies with transvaginal ultrasound-guided local injections of absolute ethanol

“…The patients can be informed of the effect of the treatment 3 h after the procedure, including one hour for gaining the blood test result, and then can go home. The success rate, although it varies in the literature, proved to be equal to or more promising than that of MTX injection [3][4][5][6][7]. The aim of AE injection is to dehydrate and destroy chorionic villi.…”

“…The success rate of treating EP with MTX is 70-95% [3][4][5][6][7], and laparoscopic treatment is necessary for failed cases. By comparison, although the failure rate with AE injection is 13%, it leaves two options for treating failed cases, i.e.…”

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

“…A dose of 1 mg/kg of MTX divided to one fifth was used in all cases. This is the lowest dose of MTX that has ever been used for local treatment of ectopic pregnancy, with the exception of the study of Merz et al [26], who recently reported similarly good results using a standard dose of 10 mg. Because of the risk of delayed intraperitoneal bleeding or late rupture of the tube [27], we kept our patients hospitalized for 3 days. Due to the excellent results, we already use this method on an outpatient basis, ,,,, and all women are discharged within a period of 2-3 h after the procedure.…”

Conservative Management of Ectopic Pregnancy with Fetal Cardiac Activity by Combined Local (Sonographically Guided) and Systemic Injection of Methotrexate

“…Yet, the existence of an ectopic embryo heart activity has been referred to as an absolute contraindication to medical treatment [9,16]. Recently, several studies have been reported, demonstrating quite a high rate of success in treating ectopic pregnancies with fetal cardiac activity by methotrexate injection [2,[4][5][6]17]. Some of the studies were based on systemic methotrexate injection [2,4], while some of them presented local sonographically guided injection of methotrexate [6,17,18].…”