Abstract
Objectives: To evaluate the efficiency and safety of intravenous mctholrcxntc as an alternative to surgery for (hetreatment of un-ruptured tubal pregnancy as well as cost effectiveness.Design: A cohort study.Setting: Madina Maternity and Children's Hospital (MMCH). Al Madinah Al Munawarah. KSA. Period from9/02/2005 to 26/06/2006 (01/01/I426H to 30/05/1427H)Methods: The authors studied thirty four patients with un-ruptured tubal cciopic pregnancies, clinically stable, whowere treated with intravenous methotrcxale according to a single-dose protocol. Prctrcalmcnl scrum concentrations ofhuman chorionic gonadotrophin (hCG) and progesterone, cndovaginal ultrasonography to asses si/.e of the mass, fetalcardiac activity and the presence of fluid in the peritoneal cavity (presumably blood) were done. All were correlatedwith the efficiency of therapy as defined by resolution of cciopic pregnancy (decline in hCG level to 15 mlU/ml or less)without the need for surgical intervention. The outcome measures also included the frequency of preservation of thelubes, subsequent ipsilaleral tubal patency and further pregnancy within one year.Results: The success rate was 88.2%. Thirty four patients of forty one (34 of 41) diagnosed as cciopic pregnancy weretreated with intravenous methotrcxate (82.9%). Twenty eight of thirty four (82.35%) were successfully treated with asingle-dose intravenous mcthotrexatc. Six patients (17.65%) needed a second dose of methotrcxate. The mean scrumchorionic gonadotrophin and progesterone concentrations were 3247.53 mlU/ml ± SD 348.1 and 8.54 ±13.1 ng/mlrespectivley. The mean time needed for serum hCG concentration to reach 15 mlU/ml or less (the resolution lime) was35.1±SD 12.8 days. Subsequent pregnancy rate within one year was 69.2% (9 women of 13). Side effects tomethotrcxate therapy were minimal.Conclusion: Single dose of intravenous methotrcxate therapy was well tolerated, cost-saving, non surgical, fallopian tube saving treatment for un-ruptured cciopic pregnancy
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