Prophylactic Single-Dose Systemic Methotrexate Therapy for High-Risk Group in Persistent Ectopic Pregnancy After Laparoscopic Conservative Surgery of Tubal Pregnancy

Abstract

Backgroud: to evaluate whether the incidence of persistent ectopic pregnancy after laparoscopic conservative surgery can be reduced or prevented by prophylactic single-dose systemic methotrexate (MTX) in high-risk group. Methods: Women who underwent laparoscopic conservative surgery for treatment of unruptured ectopic pregnancy, who agreed to participate in the study and who had risk factors for persistent ectopic pregnancy (n = 112) were randomly assigned to the prophylaxis or control group. In the prophylaxis group (n = 72), patients received a single dose of MTX, 1.0mg/kg intramuscularly, within 24 hours postoperatively. No treatment was used in the control group (n = 40). Both groups were followed with serial serum b-hCG titers; titers were measured on the frist postoperative day, then every 72 hours until levels were lower than 5mIU/ml. Results: Four women had persistent ectopic pregnancy, no in the prophylaxis group (0%) and four among the controls (10%); this difference was statistically significant (P < 0.01). One women (1.4%) reported mild side effects after MTX, but these resolved spontaneously. Conclusions: The incidence of persistent ectopic pregnancy was significantly reduced after a single prophylactic dose of systemic MTX administered postoperatively in high-risk group. This regimen is safe and can be used to decrease the extent of postoperative monitoring after conservative treatment of unruptured ectopic pregnancy.