Unruptured Tubal Ectopic Pregnancy Research Articles

Predictors of Successful Medical Management With Methotrexate in Unruptured Tubal Ectopic Pregnancy.

Introduction Medical treatment with methotrexate (MTX) is a safe and effective alternative to surgery in carefully selected cases of ectopic pregnancies diagnosed early prior to rupture. Aim To determine the optimal pre-treatment levels of beta human chorionic gonadotropin (𝛽-hCG) and its changing trends most likely to have a successful outcome with medical management. Material and methods A prospective observational study was conducted in a tertiary teaching hospital from December 2018 to May 2021. "Single-dose" MTX regime was used for medical management of ectopic pregnancy in patients fulfilling the selection criteria. The 𝛽-hCG levels were recorded at baseline and on day 4 and day 7 of MTX injection. Thereafter, at weekly intervals till complete resolution or surgical intervention due to failure of medical management. In addition, receiver operating characteristic (ROC) curve analysis for a pre-treatment 𝛽-hCG cut-off value and changing trends in post-treatment 𝛽- hCG levels most likely to have a successful outcome with MTX treatment were determined. Results Fifty patients fulfilling the inclusion criteria were included in the study, with successful medical management in 33 (66%). The mean pre-treatment 𝛽-hCGlevels in women with successful medical management were 3270.97 (+/- 901) compared to 5249.17 (+/-808.02) for those with treatment failure (p=0.00001). The mean 𝛽-hCG level in the failed treatment group was significantly higher on day 4 than the pre-treatment levels (6742.56 +/- 572 vs. 5249.17+/- 808.02; p<0.05). Inadequate reduction of 𝛽-hCG level on day 7 (<15% of day 4 levels) requiring repeat dosage of MTX was more likely to have an unsuccessful outcome (p=0.00001). The area under curve (AUC) value of 0.905 (95% CI: 0.814-0.996) depicted that pre-treatment 𝛽-hCG level of 4000 mIU/ml taken as the cut-off value was able to predict levels ≤4000 mIU/ml had a greater likelihood of successful outcome with MTX, having a sensitivity of 84.5%, specificity of 83.3%, positive predictive value (PPV) of 90.3%, and negative predictive value (NPV) of 75% (p< 0.05). Demographic variables or previous clinical history, considered risk factors for ectopic pregnancy, did not affect the outcome of medical management in this study. Conclusion Medical management of ectopic pregnancy is a viable first-line treatment option in carefully selected patients. In this study, the most important predictors for the successful outcome of medical management were the pre-treatment β-hCG levels and their fall on day 4 and day 7 after MTX therapy.

Ectopic Enigma- A Case Series of Unusual Presentations of Tubal Ectopic Pregnancy

A pregnancy that develops outside of the uterus is referred to as an ectopic pregnancy. The fallopian tube is the most typical location for ectopic pregnancy. Two percent of reported pregnancies are ectopic pregnancy. Hereby, authors present a case series of three cases, of unusual presentation of tubal ectopic pregnancy. First case was 22-year-old female, para1 living1, presented with abdominal pain, vomiting and no history of amenorrhoea. Her beta Human Chorionic Gonadotropin (HCG) was 82042 mIU/mL. A live ectopic pregnancy of 11 weeks with intact gestational sac ruptured en caul was noted on laparotomy. She underwent right salpingectomy. Second case was a 36-year-old, Abortion 2 Ectopic1, with one and a half months of amenorrhoea, abdominal pain and spotting per vagina with beta HCG of 27472 mIU/mL. Laparoscopy revealed, left sided unruptured tubal stump ectopic pregnancy and was managed by excision of tubal stump ectopic . Third case was a 26-year-old, para 2 living 2, with history of 2 months of amenorrhoea, abdominal pain and spotting per vagina. Laparotomy revealed right infundibular ectopic pregnancy with incomplete abortion with active bleeding. She underwent right salpingectomy. Cases were managed successfully. This case series emphasises the significance of having a high index of suspicion for ectopic pregnancy in all reproductive-age women regardless of their presentation.

Prediction value of creatine kinase level in conservative treated unruptured tubal ectopic pregnancies

Objectives: An ectopic pregnancy (EP) occurs when a fertilized ovum implants outside the endometrial cavity. We investigated the creatine kinase (CK) enzyme in conservatively treated EP to determine the resolution time and predict cases that may progress to surgical intervention. Methods: We include 43 patients with stable vital signs at recruitment. All participants were examined by using transvaginal ultrasound (TVUS). Beta human chorionic gonadotropin (β-hCG) and creatine kinase (CK) levels were also measured. In cases diagnosed with EP, intramuscular methotrexate (MTX) at a dose of 50 mg / m2 was administered and monitored with β-hCG titers. Follow-up continued until β-hCG titer became negative, or surgery became mandatory due to acute abdominal pain. Results: The mean β-hCG Level in the presence of an adnexal mass was statistically significantly higher than the mean level in patients in whom TVUS failed to define a mass. The mean β-hCG level in the surgical exploration group of patients was significantly higher than in those who did not require surgery. At a cut-off of 6486 mIU/mL, β-hCG could predict the emergence of acute abdomen with a sensitivity of 75% and a specificity of 94.3%. We examined CK level to contribute the test's specificity, but we found no difference among cases with and without surgical exploration. Conclusions: In patients treated conservatively for EP, CK levels at the outset neither predict an acute abdomen to emerge nor shed light on the resolution period in patients who respond to medical therapy.

Hysterosalpingography for tubal patency after methotrexate therapy for ectopic pregnancy

ntroduction: Ectopic pregnancy is a serious cause of tubal loss or dysfunction among women in the reproductive age. Medical treatment is a commonly prescribed management under certain circumstances. It is associated with a high success rate, but tubal affection is a result. This study evaluated the effect of medical treatment on patients with unruptured tubal pregnancy. Materials and methods: This was a prospective cohort study conducted at the Obstetrics and Gynecology Department of Suez Canal University Hospitals, from January 2016 to June 2019. We recruited Fifty- six patients with unruptured tubal pregnancy.All patients were managed with medical treatment, methotrexate therapy. After confirmation of successful medical treatment, hysterosalpingography was done three months after treatment for the evaluation of tubal patency.The outcome measure was the rate of tubal patency after medical treatment for unruptured tubal ectopic pregnancy. Results: The present study revealed that 71.4% of patients (40 cases) had patent tubes, and 28.6% had blocked tubes. Moreover, 21.4% of patients have ipsilateral tubal block only, 3.6% have a contralateral tubal block, and 3.6% have a bilateral tubal block. Significant risk factors for tubal block were history suggestive of PID, acute PID hospitalization, and history of septic miscarriage (p value &lt; 0.05). Conclusion: Methotrexate provided successful fertility-preserving treatment for women with unruptured ectopic pregnancy, yet associated with tubal block

Methotrexate for the treatment of unruptured tubal ectopic pregnancy.

The objective of this study was to determine the outcomes of women who presented to the emergency department (ED) with suspected ectopic pregnancy and received methotrexate as first-line treatment. This was a retrospective chart review of pregnant (&lt; 12 week' gestational age) women from an academic tertiary care ED with a diagnosis of ectopic pregnancy, rule-out ectopic pregnancy, or pregnancy of unknown location over a 7-year period. Of 612 patients with a suspected ectopic pregnancy at initial ED presentation, 326 (53.3%) had non-ectopic pregnancy outcomes, 30 (4.9%) were diagnosed with a ruptured ectopic pregnancy at the index ED visit, and 18 (2.9%) were diagnosed and managed as non-tubal ectopic pregnancies and excluded from further analyses; 238 patients were diagnosed with a tubal ectopic pregnancy, and 152 (63.9%) were treated with methotrexate at the index ED visit or in follow-up. Of patients treated with methotrexate, 27 (17.8%) went on to require surgical management, with 17 (11.2%) documented as having ruptured on surgical evaluation. The proportion of patients failing methotrexate as first-line treatment was higher than previously reported. Further investigation is needed to determine whether methotrexate failure was due to non-adherence to recommended guidelines.

Unusually Large, Unruptured Tubal Ectopic Pregnancy Mass in a Woman With Bilateral Tubal Obstruction Treated by Laparoscopy: A Case Report

A tubal ectopic pregnancy mass usually measures 1.5 - 3.5 cm, and ruptures if it grows beyond this size. The author encountered a case of an unruptured, tubal ectopic pregnancy mass measuring up to 7.3 cm, containing an embryo with a crown-rump length (CRL) of 2.02 cm, corresponding to 8 weeks, 4 days. To the author’s knowledge, this is the largest reported singleton tubal ectopic pregnancy mass. A 36-year-old gravida 0, para 0 woman presented with a history of mild vaginal bleeding, lower abdominal pain, and 8 weeks of amenorrhea. Vaginal bleeding started 3 weeks before, but she mistook this for menstruation. Her menstrual cycle ranged between 28 and 30 days and lasted 6 days. Her last menstrual period was about 8 weeks prior. She had an appendectomy 22 years prior. She was diagnosed with infertility due to tubal obstruction and underwent laparoscopic fimbrioplasty at another general hospital 13 years prior. She was told that her Fallopian tubes were still obstructed on hysterosalpingography after fimbrioplasty. She had not used contraception. On arrival in the emergency room, her serum beta-human chorionic gonadotropin (hCG) level was 15,944 mIU/mL. The transvaginal ultrasound scan (TVUS) demonstrated an ectopic pregnancy mass measuring 7.3 × 4.0 cm in the left adnexa. An embryo with CRL of 2.02 cm corresponding to 8 weeks, 4 days was noted in the ectopic pregnancy mass. Upon entering the pelvic cavity, a dark reddish-colored unruptured tubal ectopic pregnancy mass was noted. Laparoscopic salpingectomy was carried out. The right Fallopian tube was adherent to the right pelvic wall. Even though the Fallopian tubes are obstructed, pregnancy is still possible. Laboratory studies should always include a pregnancy test. A large tubal ectopic pregnancy mass could have developed when a blastocyst was implanted in a fused Fallopian tube that was adherent to the pelvic peritoneum and uterus. J Med Cases. 2016;7(9):396-398 doi: http://dx.doi.org/10.14740/jmc2613w

The effect of parental 5,10-methylenetetrahydrofolate reductase 677C/T and 1298A/C gene polymorphisms on response to single-dose methotrexate in tubal ectopic pregnancy

Object: The aim of this study was to assess the effect of parental 5,10-methylenetetrahydrofolate reductase (MTHFR) gene polymorphisms (677C/T and 1298A/C) on response to single-dose methotrexate (MTX) treatment in tubal ectopic pregnancy (TEP).Materials and methods: In this prospective cohort study, cases with unruptured TEPs were grouped into two according to their response to single-dose MTX treatment (Group 1: responsive, n:88; Group 2: unresponsive, n:21). The groups were compared with regard to baseline demographic and clinical parameters. As a main outcome measure, the independent effects of parental MTHFR gene polymorphisms on response to single dose MTX treatment were evaluated.Results: One hundred and nine unruptured TEP were included in the final analysis. The mean maternal age was 29.30 ± 5.21 years, gravity 2 (min–max: 1–5), parity 1 (min–max: 0–4). The median serum beta-human chorionic gonadotropin (β-hCG) was 1403.35 MI/I (Q1–Q3: 517–2564). The overall response rate was 81% (88/109). The groups were similar with respect to basic baseline demographic data and serum β-hCG level. Binary logistic regression analysis showed that the presence of parental MTHFR677C/T and 1298A/C polymorphism were not independent factor predicting treatment success (p > 0.05). The only independent factor for resistance to single dose MTX was the previous TEP (OR: 4.47 (1.18–16.9)).Conclusion: Parental MTHFR 677C/T and 1298A/C mutations do not predict the outcome of single dose intramuscular MTX treatment in unruptured TEP.

Evaluation of mean platelet volume in unruptured ectopic pregnancy: A retrospective analysis

We aimed to investigate and compare the mean platelet volume (MPV) levels in ectopic and viable intrauterine pregnancy (IUP). The medical records of 78 unruptured tubal ectopic pregnancy patients (TEP, Group 1) and 150 patients with viable IUP (Group 2) served as control group between May 2014 and February 2015 in our clinic were retrospectively analysed. The demographic characteristics including age, parity, gravida, abortus, haemoglobin levels and leucocyte counts showed no statistically difference between two groups. The mean MPV level was significantly lower in TEP group compared to IUP group (8.69 ± 1.14 and 10.06 ± 1.46, p < 0.001). The platelet (PLT) distribution width was higher in TEP group, however, there was no statistical difference between the two groups (p = 0.078). The early diagnosis of TEP is crucial in order to prevent maternal morbidity and mortality. Our results showed that MPV is lower in TEP than IUP and it seems to be related with the possible inflammation at implantation site of tuba uterina. However, there is need for further studies for employing PLT indices in the diagnosis of TEP.

Unusually Large, Unruptured Tubal Ectopic Pregnancy Mass in a Woman With Bilateral Tubal Obstruction Treated by Laparoscopy: A Case Report

Unusually Large, Unruptured Tubal Ectopic Pregnancy Mass in a Woman With Bilateral Tubal Obstruction Treated by Laparoscopy: A Case Report

Advanced Tubal Ectopic Pregnancy with Tubal Torsion

Abstract Background: At least 90% of all ectopic pregnancies are located in the Fallopian tubes. Rupture rates differ according to localization of the ectopic masses. Isthmic ectopic pregnancies are more likely to rupture than ampullary ectopic pregnancies. Cornual pregnancies are capable of reaching further weeks of gestation. Abdominal ectopic pregnancies may even reach full-term, which is a very rare situation. Case: This article presents a case of an advanced unruptured tubal ectopic pregnancy reaching beyond the first trimester. A 36-year-old woman, gravida 4, para 2, curetage 1 was admitted to the emergency department of the Kanuni Sultan Suleyman Training and Research Hospital, in Istanbul, Turkey. She had severe abdominal pain and was admitted with clinical findings of a ruptured ectopic pregnancy. At exploration, an unruptured tubal ectopic pregnancy of 13 weeks and 3 days' duration was observed in the patient's right Fallopian tube during the operation. There was a fetus inside this Fallopian tu...

Serum β-hCG levels post-treatment of ectopic pregnancy with a single dose of intramuscular methotrexate.

The cytotoxic management of ectopic pregnancy using a single dose of intramuscular methotrexate injection has been well established as effective for a select number of women with unruptured tubal ectopic pregnancy where there are minimal symptoms. The purpose of this study was to create centile curves of serum β-hCG levels following successful treatment with a single dose of 50mg/m(2) of intramuscular methotrexate to treat ectopic pregnancy. Data were retrieved from women treated at the Royal Women's Hospital for ectopic pregnancy between 2006 and 2012. Only women with minimal symptoms, initial serum β-hCG ≤5000IU/L and ectopic mass size of ≤35mm on ultrasound were included. Two hundred and fifty-three cases of ectopic pregnancy were analysed. Initial β-hCG of women in the study ranged from 18 to 3995IU/L with a median of 497 (25th to 75th centiles; 222-1160) IU/L. The median levels of β-hCG levels at day 4, 7 and 14 postmethotrexate injection were 73.8, 47.2 and 10.4% of the initial β-hCG level, respectively. The 90th centiles of β-hCG levels at day 4, 7 and 14 were 124.7, 93.8 and 40.0% of initial β-hCG level, respectively. Whilst no comparison with those unsuccessfully treated was made, pending further validation studies, the use of these curves may reduce the reliance on specialist units and streamline care for many women with ectopic pregnancy, such as those whose β-hCG regress in line with centile values without crossing a certain threshold.

Transvaginal Aspiration of Ectopic Gestational Sac: A Novel Treatment Option in Tubal Ectopic Pregnancies

ABSTRACTObjectiveTo present five cases of unruptured tubal ectopic pregnancies treated with ultrasound-guided aspiration with local potassium chloride (KCl) or systemic methotrexate (MTX) administration.DesignCase series.SettingA hospital-based prospective study.PatientsFive women with unruptured tubal ectopic pregnancy.InterventionsTransvaginal ultrasound-guided aspiration of tubal ectopic pregnancy followed by local KCl or intramuscular injection of MTX (50 mg/m2).Main outcome measuresSuccessful conservative treatment of tubal ectopic pregnancies with preservation of fallopian tubes.ResultsFour (80%) out of five women weres uccessfully treated, without the need for operative intervention. One patient required salpingectomy for ruptured ectopic pregnancy during the course of treatment.ConclusionTransvaginal ultrasound-guided aspiration of ectopic gestational sac along with either local KCl or systemic methotrexate administration can be safely used to treat unruptured tubal ectopic pregnancies in selected patient population.How to cite this articleMishra VV, Choudhary S, Sharma U, Agarwal R. Transvaginal Aspiration of Ectopic Gestational Sac: A Novel Treatment Option in Tubal Ectopic Pregnancies. J South Asian Feder Obst Gynae 2015;7(1):1-4.

Spontaneous bilateral ruptured and unruptured tubal ectopic pregnancies: a case report and literature review from Niger Delta Nigeria

Historically ectopic pregnancy and it's complications account for the most leading cause of first trimester maternal deaths in the world. Bilateral tubal pregnancies in the absence of a preceding induction of ovulation (or tubal manipulation for assisted conception) are very rare occurrences and are associated with high potentials for causing maternal mortality. We herein report an uncommon mode of presentation of an ectopic pregnancy in a multi-parous woman, with a spontaneous bilateral tubal pregnancy. The Patient presented in shock, which was caused by a ruptured right ampullary tubal ectopic pregnancy with massive haemoperitoneum. During a life saving emergency exploratory laparotomy which showed a ruptured right ectopic pregnancy, an enlarged unruptured left ampullary mass highly suspicious of ectopic pregnancy was also removed. Both tubal pathologies were confirmed as ectopic gestations histopathologically. This case underscores the variety of such occurrences, a high index of suspicion, judicious intra-operative inspection of the contra lateral tube and histopathological evaluation of the specimens.

Bilateral tubal ectopic gestation: A case report

Spontaneous bilateral tubal ectopic pregnancy is a rare occurrence. A case of a recently managed spontaneous bilateral tubal ectopic pregnancy is discussed. A 37-year-old grand multiparous farmer, who had been amenorrhoeic for 12 weeks, presented with lower abdominal pain, bleeding per vaginam, and dizziness. Other clinical and ultrasonographic findings were suggestive of ruptured ectopic gestation. Intra-operative findings included ruptured right tubal and unruptured left tubal ectopic pregnancies. Bilateral partial salpingectomy was performed with uneventful recovery. Intra-operative diagnosis of bilateral tubal ectopic pregnancy was confirmed by histology of the specimens.

Persistent molar pregnancy in an ectopic tubal pregnancy treated with laparoscopic surgery: A case report

Introduction: Molar pregnancy presenting as an ectopic pregnancy is very rare with only occasional cases being previously reported. Case Report: A 50­year­old Asian female underwent a successful laparoscopic salpingectomy of an unruptured tubal ectopic pregnancy. The histopathology confirmed a complete molar pregnancy within the tubal specimen. Post­ operatively, after an initial fall, there was a gradual increase in her s subunit of human chorionic gonadotropin (s­hCG) levels. The patient requested surgical intervention and she underwent total laparoscopic hysterectomy, left salpingooophorectomy, right oophorectomy and removal of residual right fallopian tube. The histopathology revealed no residual trophoblastic tissue in the excised specimen. Her s­hCG returned to normal postoperatively. Conclusion: This case report is the first example of persistent molar pregnancy of the fallopian tube being treated with completion surgery and highlights that this is an effective treatment of this rare condition.

The Prognostic Value of Tubal Patency Test After Medical Treatment of an Ectopic Pregnancy

Background : Ectopic pregnancy (EP) is defined as the abnormal implantation of the blastocyst outside the uterine endometrium. The most common site of implantation is the Fallopian tube. The effect of different management strategies on subsequent fertility following tubal ectopic pregnancy is unknown. Some women who have had ectopic pregnancies will have difficulty becoming pregnant again. The aim of this study is to evaluate the tubal patency after successful medical treatment of an un-ruptured tubal ectopic pregnancy with systemic methotrexate (MTX). M ethods: This is an observational retrospective study carried out on 72 women diagnosed as un-ruptured tubal ectopic pregnancy. Systemic treatment with a single dose methotrexate (50 mg/m 2 intramuscularly) was used for 32 women and 40 cases underwent surgery. Hysterosalpingography (HSG) was performed on 30 patients (successfully managed with methotrexate) and 40 cases that underwent unilateral salpingectomy (as initial treatment). Results: The medical treatment with single dose MTX for EP was effective (93.8%) as a primary treatment. In the MTX group, the HSG findings from the ipsilateral tube showed that 83.3% the diseased tubes were open and 16.7% were obstructed. The contralateral tube was patent in 93.3% and obstructed in 6.7%. In salpingectomy group the contralateral tube was patent in 82.5% and obstructed in 17.5%. Conclusion: For an un-ruptured tubal EP, the medical treatment with MTX is effective. Routine HSG following medical treatment does not seem necessary but might be considered in selected risk cases. doi: http://dx.doi.org/10.4021/jcgo48w

An alternative treatment option in tubal ectopic pregnancies with fetal heartbeat: aspiration of the embryo followed by single-dose methotrexate administration

To present 13 cases of unruptured tubal ectopic pregnancies successfully treated with ultrasound-guided aspiration and local and systemic methotrexate (MTX) administration. Case series. University hospital. Thirteen women with an unruptured tubal ectopic pregnancy. Transvaginal ultrasound-guided aspiration of the tubal ectopic pregnancy followed by MTX administration into the gestational sac (half of the calculated total dose of 25 mg/m(2)) and intramuscular injection (the remaining half of the calculated total dose of 25 mg/m(2)). Recovery of the patients, successful conservative treatment of the tubal ectopic pregnancies with preservation of the fallopian tubes. Twelve (92%) of 13 women were successfully aborted, without need for salpingectomy or salpingostomy. Transvaginal ultrasound-guided aspiration of fetus followed by local and systemic methotrexate administration can be safely used to treat unruptured tubal ectopic pregnancies.

Comparison of single-dose and two-dose methotrexate protocols for the treatment of unruptured ectopic pregnancy

SummaryThe purpose of this study was to compare the safety and success rates of single- and two-dose methotrexate (MTX) protocols for the treatment of unruptured tubal ectopic pregnancy. This retrospective study included 87 patients with ectopic pregnancy who were treated with MTX therapy (single-dose protocol: 46 patients; two-dose protocol: 41 patients). Both protocol groups were compared with regard to success rates, β-hCG and progesterone levels, the presence of cardiac activity, a history of previous ectopic pregnancy, ectopic mass size, gestational age, adverse events, and number of repeat MTX doses. Success rates between the single-dose and two-dose methotrexate therapy groups were comparable (87% vs 90.2%; OR 0.7, 95% CI 0.18–2.75; p = 0.74). No significant differences were found between the groups in factors influencing MTX treatment success rate, including the mean β-hCG level, mean progesterone level, the presence of a positive cardiac activity, mean ectopic mass size, mean endometrial thickness, and the presence of a yolk sac. There were also no significant between-group difference were found in the percentage of women who needed a repeat dose of MTX (17.3% vs 7.3%; OR 0.3, 95% CI 0.09–1.52; p = 0.20) and in the percentage of adverse events (45.7% vs 58.7%; OR 1.6, 95% CI 0.71–3.93; p = 0.28). In conclusion, medical treatment with single-dose or with two-dose systemic MTX seem to be equal therapeutic options for patients with unruptured ectopic pregnancy.

Methotrexate Treatment Of Ectopic Pregnancy: Experience at Nizwa Hospital with Literature Review

Ectopic pregnancy occurs when the embryo fails to implant within the uterine cavity. Methotrexate, a folic acid antagonist has been widely used to treat ectopic pregnancy. The aim of this study is to determine the efficacy of methotrexate treatment for ectopic pregnancies in our settings which will in-turn help us reduce maternal mortality and morbidity. This was a retrospective review of 60 cases of ectopic pregnancy treated with single dose methotrexate in Nizwa hospital, Oman. Demographic data, clinical presentation, treatment progress, outcome, side effects and future fertility follow up were analysed using a computer database. Selection criteria included hemodynamically stable women with ß-hcg level of ≤5000 mIU/ml, adnexal mass ≤4 cm, absent cardiac activity and hemoperitoneum less than 100 ml. Human chorionic gonadotrophin (hcg) assay and clinical presentation were used to determine cases which warranted surgical intervention. The success rate of single dose methotrexate therapy in our study was 65% (n=39) and 35% (n=21) required surgical intervention compared to reported success rate of 67-100% published in various studies. Careful selection of cases and confining strictly to the criteria improved the success rate from 40% to 60% in five and half years of the study. The mean average time of resolution of ectopic pregnancy was 32 days for a single dose and 58 days for repeat second or third doses. Eight cases of pregnancy of unknown location were treated successfully with Methotrexate. No major side effects were noted. A successful fertility outcome of 30% in the first year followed by 13.3% in the subsequent second year with a secondary infertility rate of 11.6% was observed in this study. Methotrexate treatment of ectopic pregnancies is safe and effective with no major side effects. Intramuscular methotrexate has the advantage of tubal conservation and saves patients from requiring surgery. It is easier to administer than intraoperative route, which is by laparoscopy and needs expertise. Our study showed single dose methotrexate to be an effective treatment option for selected patients with unruptured tubal ectopic pregnancy.

Comparison of single and multiple dose methotrexate therapy for unruptured tubal ectopic pregnancy: a prospective randomized study

To compare the success rates of single and multiple dose methotrexate protocols for the treatment of unruptured tubal ectopic pregnancy. Prospective randomized controlled trial. Maternity and teaching hospital in Turkey. One hundred twenty women treated with methotrexate therapy for unruptured tubal ectopic pregnancy. Sixty-two women received a single dose and 58 received a multiple dose methotrexate regimen. Success rate of methotrexate therapy (women successfully treated with one injection and women who completed four doses). In the single dose group, treatment was considered successful in 50 women (80.6%), whereas in the multiple dose group, 52 women (89.7%) responded to treatment (p = 0.21; OR 0.90, 95%CI 0.77-1.05). The average number of days required for human chorionic gonadotropin (hCG) levels to fall below 5 mU/mL was longer in the single dose (22.3 +/- 7.6) compared with the multiple dose group (18.3 +/- 10.7) (p = 0.03). In the single dose group fewer or 17 women (24.7%) experienced side-effects compared to 28 (48.3%) of those who had multiple doses (p = 0.02, OR 0.57, 95%CI 0.35-0.92). A multiple dose methotrexate regimen for the treatment of unruptured tubal ectopic pregnancy is not more effective than a single dose one. In addition, multiple doses may cause more side-effects, but the time for hCG levels to fall below 5 mU/mL is shorter.