METHOTREXATE PROPHYLAXIS FOR PERSISTENT ECTOPIC PREGNANCY AFTER CONSERVATIVE TREATMENT BY SALPINGOSTOMY

Objective: To investigate whether the incidence of persistent ectopic pregnancy after linear salpingostomy can be reduced by prophylactic ad ministration of a single dose of methotrexate postoperatively. Methods : Women who underwent linear salpingostomy for treatment of unruptured ectopic pregnancy and who agreed to participate in the study (n = 129 ) were randomly assigned to the prophylaxis or control group. Women wi th anemia, renal insufficiency, or liver disease were excluded. In the prophylaxis group, patients received a single dose of methotrexate, 1 mg/kg intramuscularly, within 24 hours postoperatively. No treatment was used in the control group. Both groups were followed with serial s erum beta-hCG titers; titers were measured on the seventh postoperativ e day, then every 72 hours until levels were lower than 15 mIU/mL. A b lood count and chemistry panel were also obtained on postoperative day 7, and any side effects related to methotrexate were noted. Persisten t ectopic pregnancy was defined as a rise in the serum beta-hCG level or a decline of less than 20% between two consecutive measurements tak en 3 days apart. Results: A total of 116 women completed the postopera tive follow-up: 54 in the prophylaxis group and 62 in the control grou p. Ten women had persistent ectopic pregnancy, one in the prophylaxis group (1.9%) and nine among the controls (14.5%); this difference was statistically significant (P < .05). The relative risk of developing p ersistent ectopic pregnancy after prophylactic methotrexate was 0.13 ( 95% confidence interval 0.02, 0.97). Three women (5.5%) reported mild side effects after methotrexate, but these resolved spontaneously. Con clusion: The incidence of persistent ectopic pregnancy was significant ly reduced after a single prophylactic dose of systemic methotrexate a dministered postoperatively. This regimen is safe and can be used to d ecrease the extent of postoperative monitoring after conservative trea tment of unruptured ectopic pregnancy. Copyright (C) 1997 by The Ameri can College of Obstetricians and Gynecologists.