Medical Management of Unruptured Ectopic Pregnancy with Methotrexate and its Outcome

Abstract

Ectopic pregnancy (EP) is a classic gynecologic emergency and remains a major cause of maternal morbidity and mortality. The combination of serum beta hCG titre and transvaginal sonography have supplanted physical examination findings as the most accurate diagnostic tool for determining the site of ea rly gestation. Early diagnosis by transvaginal scan has facilitated the move towards medical therapy with methotrexate for most women with unruptured ectopic pregnancies. Our study aims to analyze the outcomes of medically managed unruptured ectopic pregnancies treated with methotrexate and to correlate them with serum β -hCG levels. Patients who fulfilled the inclusion criteria for medical management of unruptured ectopic pregnancy (β -hCG >1500 mIU/mL and <10000 mIU/mL) with transvaginal scan feature s suggestive of unruptured ectopic pregnancy were included in the study for either single or multiple dose methotrexate . Main outcomes analysed were the success rates of single & multiple dose MTX regimens. Secondarily the correlation between β hCG levels on D1, D4, D7 and the success rates of medical management was analyzed. Conclusion- Medical management of unruptured ectopic pregnancy with methotrexate has been successful in 80% of our study group, with least side effects and hence can be recommended as the first line of management in selected group of early unruptured ectopic pregnancies