EFFICACY AND SAFETY OF SINGLE-DOSE SYSTEMIC METHOTREXATE IN THE TREATMENT OF ECTOPIC PREGNANCY

Objective: To evaluate the safety and efficacy of single-dose systemic methotrexate (MTX) in the treatment of ectopic pregnancy (EP). Design : A database was started and continued prospectively for 35 patients m eeting criteria for MTX therapy from June 1991 to October 1993. Follow -up was performed retrospectively on all patients with EPs (n = 82) by evaluating hospital and clinic records and by contacting affiliated p hysicians and individual patients. Setting: The University of Vermont Reproductive Endocrinology Service. Interventions: Methotrexate 50 mg/ m(2) was administered IM; blood samples were collected on days 0, 4, a nd 7 of MTX therapy and weekly thereafter until hCG titers became <4 m IU/mL. Results: Thirty-five of 82 (42.7%) patients diagnosed with EP w ere treated with MTX. The mean hCG concentration on day of treatment w as 1388.1 +/- 463.5 (+/-SE) mIU/mL, and mean time to complete resoluti on of hCG was 23.1 +/- 2.9 days. Thirty of 35 (85.7%) were successfull y treated with a single dose of MTX. Five of 35 (14.3%) failed therapy and required laparoscopic surgery. Twelve of 35 (34.3%) experienced m ild side effects that resolved spontaneously. Ten of 13 (76.9%) demons trated tubal patency at follow-up hysterosalpingogram. Of the 15 patie nts seeking pregnancy, 3 of 15 (20.0%) conceived, resulting in 3 term deliveries and 2 spontaneous abortions. Conclusions: Our results suppo rt the use of single-dose systemic MTX for the treatment of unruptured EP in carefully selected patients.