Values and predictive factors for Success of Methotrexate Therapy in Medical Management of Ectopic Pregnancy

Abstract

Background: Using Methotrexate as an option for medical treatment of ectopic pregnancies has been suggested since 1982. Studies regarding the dose, number of doses of methotrexate and the predictive factors of degree of success of methotrexate in the medical management of ectopic pregnancy are limited. Aim of the present article were; to assess the predictive factors of success and efficacy of methotrexate therapy and to assess the value and efficacy of using lower dose of methotrexate and the suitable number of doses for medical management of ectopic pregnancy. Methods: we included 100 patients with ectopic tubal pregnancy that were given Methotrexate dosage 1 mg/kg which was injected intramuscular. After the first injection we asked the patients to return on the 4 th day then on the 7 th day to test the levels of hCG. In case of reduction of the level of β-hCG less than 15% on 4 th and 7 th days, patients were given the second methotrexate dose of 1 mg/kg which was also injected intramuscular. We followed patients until achieving β-hCG target level (<15 mIU/mL) then completely negative values. We assessed rates and predictive factors for success or failure of methotrexate therapy. Results: of the included 100 patients, 15 patients needed surgical management at the end of treatment, with a success rate of medical Methotrexate therapy of 85%.The pretreatment predictive factors of failure of medical treatment are; presence of a pretreatment adnexal mass (p= 0.040), presence of pain (p= 0.039), metrorrhagia (p= 0.023), or hemoperitoneum (p= 0.002). Base line pretreatment hCG levels was the most important predictive factor of therapy success (p= 0.002). Conclusions: methotrexate in a single dose or two doses could effectively treat ectopic pregnancy with fewer side effects providing that base line hCG level < 5000 IU/L in hemodynamically stable young patients with no liver or kidney problems with a higher success rate.

Efficacy of Methotrexate Treatment, Nonsurgical Treatment of Ectopic Pregnancy (EP)

“…In 1980 Tanaka et al introduced methotrexate as a successful treatment option for EP first time. 19 Our study showed the success rate of the methotrexate treatment in EP 73% which is lower as compared to 89%, 90.2% as found in other studies 20,21 .…”