Clinical and pregnancy outcome following ectopic pregnancy; a prospective study comparing expectancy, surgery and systemic methotrexate treatment

Background. The improved possibility of an early diagnosis of ectopic pregn ancy by use of serial quantitative beta-subunit human chorionic gonadotropi n hormone levels together with transvaginal ultrasound has opened up option s for conservative treatment. Systemic methotrexate treatment of un-rupture d ectopic pregnancy has emerged as a safe and effective alternative to surg ical procedures. The aim of the present study was to investigate the effect iveness of methotrexate treatment in routine clinical practice, but also to assess pregnancy outcome during a 2.5-year follow-up period. Methods. All patients presenting to the Department of Obstetrics and Gyneco logy, Umea University Hospital, with signs and symptoms of ectopic pregnanc y between January 1, 1995 and December 31, 1997 were included in this prosp ective study. Patients with ectopic pregnancy were either managed expectant ly, treated with methotrexate or by laparoscopic or open surgery (salpingos tomy/salpingectomy). Systemic methotrexate (Pharmacia & Upjohn, Stockholm, Sweden) was administered as an intramuscular injection of 50 mg/m(2). Results. One hundred and seven patients presented with signs and symptoms o f a possible ectopic pregnancy, of these 89 patients eventually were diagno sed as having an ectopic pregnancy. Twenty-six (29%) patients were treated with methotrexate, 46 (52%) patients with laparoscopy or laparotomy, and 17 (19%) patients by expectant management. Success rate in the methotrexate g roup, after one or more injections, was 77% (20 patients out of 26). The me an time to resolution was 24 +/- 9 days. There was no difference in pregnan cy rate following methotrexate treatment compared to surgical treatment. Conclusions. Systemic single-dose methotrexate treatment is a safe treatmen t option with a reasonably high success rate, with similar probability of a later intrauterine pregnancy as conventional surgical treatment.