Cs. Stika et al., SINGLE-DOSE METHOTREXATE FOR THE TREATMENT OF ECTOPIC PREGNANCY - NORTHWESTERN-MEMORIAL-HOSPITAL 3-YEAR EXPERIENCE, American journal of obstetrics and gynecology, 174(6), 1996, pp. 1840-1846
OBJECTIVE: Our purpose was to evaluate the effectiveness of single-dos
e intramuscular methotrexate in the treatment of ectopic pregnancies b
y physicians in the Department of Obstetrics and Gynecology of Northwe
stern Memorial Hospital and to compare the results with those of previ
ously published studies. STUDY DESIGN: A retrospective chart review wa
s performed of 50 patients with ectopic pregnancies treated with singl
e-dose methotrexate according to the protocol of Stovall et al. from J
anuary 1992 to February 1995. RESULTS: The mean pretreatment level of
beta-human chorionic gonadotropin was 1896.4 +/- 2399 mlU/ml. Only 32
women (64%) were successfully treated with a single dose of methotrexa
te. An additional 7 women required a second or third injection. The co
mbined success rate for medical management of ectopic pregnancy with o
ne to three doses of methotrexate was 78% (39 women). Pretreatment bet
a-human chorionic gonadotropin levels were significantly lower in wome
n who responded to single-dose therapy than in those who required eith
er two or three doses or who had failure of medical management (p = 0.
0011), The mean time to resolution of beta-human chorionic gonadotropi
n was 26.5 +/- 17 days. Higher pretreatment levels correlated with lon
ger resolution time (r = 0.83, p < 0.001). Eleven women (22%) with fai
lure of medical management required surgery. CONCLUSIONS: In our serie
s single-dose methotrexate was only 64% successful. Women with a pretr
eatment beta-human chorionic gonadotropin level >5000 mlU/ml had a gre
ater probability of requiring either surgical intervention or multiple
doses of methotrexate. The potential for emergency surgery remains an
important risk.