Patient Adherence to Medical Management of Ectopic Pregnancy

Abstract

INTRODUCTION: Ectopic pregnancies comprise approximately 1–2% of all pregnancies. Single-dose methotrexate is an acceptable treatment for nonruptured ectopic pregnancies. Less than one in five inner-city underserved patients comply with follow-up protocols after methotrexate. Alternative protocols with less follow-up visits are available but are not currently the standard of care secondary to less known morbidity and failure. The objective of this study was to evaluate adherence to an established single-dose methotrexate protocol, specifically typical follow-up and associated morbidity in inner-city patients. METHODS: We performed a retrospective chart review of patients treated for ectopic pregnancy with methotrexate from January 2009 to December 2012. Data were collected on demographics, medical history, barriers to follow-up, dates of follow-up, human chorionic gonadotropin levels, methotrexate doses given, and surgical interventions. RESULTS: A total of 125 patients were included. No specific follow-up trend existed, but 75% of patients followed up for one additional blood draw as follows: day 4 (41%), day 8 (33.3%), day 5 (31.7%), and day 7 (27.5%). Recommend follow-up on both days 4 and 7 was only 18.3%. No significant differences in morbidity or treatment failure were associated with patterns of follow-up. CONCLUSIONS: Overall adherence to an established methotrexate protocol is poor. Patient follow-up did occur but not per the recommended protocol. Treatment success was not affected by nonadherence, suggesting that alternative protocols may be safely considered. Further evaluation of alternative protocols to improve compliance and confirm safety is recommended.