SINGLE-DOSE METHOTREXATE FOR THE TREATMENT OF ECTOPIC PREGNANCY - NORTHWESTERN-MEMORIAL-HOSPITAL 3-YEAR EXPERIENCE

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.