Abstract
Background. One of the treatment modalities for ectopic pregnancy is methotrexate. The purpose of this study is to identify the failure rate of methotrexate in treating patients with ectopic pregnancy as well as the risk factors leading to treatment failure. Methods. A retrospective chart review of 225 patients who received methotrexate as a primary management option for ectopic pregnancy. Failure of single dose of methotrexate was defined as drop of BHCG level less than or equal to 14% in the seventh day after administration of methotrexate. Results. 225 patients had methotrexate. Most of the patients (151 (67%)) received methotrexate based on the following formula: f 50 mg X body surface area. Single dose of methotrexate was successful in 72% (162/225) of the patients. 28% (63/225) were labeled as failure of single dose of methotrexate because of suboptimal drop in BhCG. 63% (40/63) of failure received a second dose of methotrexate, and 37% (23/63) underwent surgical treatment. Among patient who received initial dose of methotrexate, 71% had moderate or severe pain, and 58% had ectopic mass size of more than 4 cm on ultrasound. Conclusion. Liberal use of medical treatment of ectopic pregnancy results in 71% success rate.
Highlights
Implantation of a fertilized ovum outside the uterine cavity is known as ectopic pregnancy (EP) [1,2,3]
Medical records of patients admitted to KAMC with a diagnosis of ectopic pregnancy which were retrospectively reviewed in the period between 2005 and 2011 were screened
Failure is defined in two ways: firstly, as suboptimal drop in BHCG level to 14% or less that necessitate second dose of methotrexate or surgical treatment; secondly, as the need for emergency laparoscopy or laparotomy in case of hemodynamic instability or severe abdominal pain
Summary
Implantation of a fertilized ovum outside the uterine cavity is known as ectopic pregnancy (EP) [1,2,3]. One of the treatment modalities for ectopic pregnancy is methotrexate. The purpose of this study is to identify the failure rate of methotrexate in treating patients with ectopic pregnancy as well as the risk factors leading to treatment failure. A retrospective chart review of 225 patients who received methotrexate as a primary management option for ectopic pregnancy. Single dose of methotrexate was successful in 72% (162/225) of the patients. 28% (63/225) were labeled as failure of single dose of methotrexate because of suboptimal drop in BhCG. 63% (40/63) of failure received a second dose of methotrexate, and 37% (23/63) underwent surgical treatment. Among patient who received initial dose of methotrexate, 71% had moderate or severe pain, and 58% had ectopic mass size of more than 4 cm on ultrasound. Liberal use of medical treatment of ectopic pregnancy results in 71% success rate
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