Reproductive performance after methotrexate treatment of ectopic pregnancy

The purpose of this study was to examine return of reproductive potential, hysterosalpingographic findings, and time to conception in patients treated with methotrexate and citrovorum factor for unruptured ectopic pregnancy. Fifty-seven patients with unruptured ectopic pregnancies less than 3.0 cm in greatest dimension were treated with methotrexate and citrovorum factor. The mean time from resolution of the ectopic pregnancy to return of menses was 26.0 (0 to 157) days. Forty-four patients were available for follow-up (2 to 15 months). Nineteen of 23 patients who had hysterosalpingograms demonstrated patency in the ipsilateral tube. Fourteen patients desired pregnancy; 11 of 14 (78.6%) were successful, with 10 of 11 (90.9%) having an intrauterine pregnancy, whereas one of 14 (9.1%) were extrauterine gestations. The mean time from first attempt to achieving pregnancy was 2.3 (1 to 4) months. We conclude that methotrexate and citrovorum factor treatment of unruptured ectopic pregnancy is associated with subsequent tubal patency and does not impair return of menses. Most importantly, the pregnancy rates after this form of therapy appear to be better than those achieved by traditional surgical methods, and are comparable to results after laparoscopic salpingostomy.     

Local methotrexate injection: a nonsurgical treatment of ectopic pregnancy

Twenty seven patients with unruptured tubal pregnancy were selected for nonsurgical treatment with the use of one injection of 12.5 mg of methotrexate into the ectopic site at laparoscopy. No adverse reactions were observed. In three patients (11%), a laparotomy was performed because of rising beta-human chorionic gonadotropin titers. In the other patients, serum beta-human chorionic gonadotropin levels decreased to the nonpregnant range with no further intervention, and the patients recovered uneventfully. This method is suggested as an alternative to surgery in selected cases of early unruptured tubal pregnancy.     

Pharmacokinetics of methotrexate after local tubal injection for conservative treatment of ectopic pregnancy.

Methotrexate peak level after intratubal injection was found to be significantly lower than the accepted toxic level. After IM injection, MTX peak level and the AUC were found to be similar to the levels observed after intratubal injection. The advantage of tubal injection over IM injection is challenged.     

Conservative treatment of ectopic pregnancy with methotrexate

Six subjects with distal ampullary ectopic pregnancies were treated with four doses of intravenous methotrexate (1.0 mg/kg) followed by four doses of leucovorin (0.1 mg/kg, intramuscularly). The diagnosis was established in all cases by laparoscopy following sonography and radioimmunoassay for serum beta subunit of human chorionic gonadotropin. Subjects were followed with daily quantitative serum beta-human chorionic gonadotropin radioimmunoassay and sonography. Five of the six subjects experienced resolution of their ectopic pregnancy without additional surgical treatment. One subject underwent salpingectomy following treatment. Morbidity also included three patients with mild stomatitis or gastritis, and two patients had transient elevations of serum transaminase levels. Two patients had protracted courses and received blood transfusions. The most abrupt response and most uncomplicated courses were experienced in the three subjects with initial human chorionic gonadotropin levels below 1000 mIU/ml. This preliminary experience suggests that methotrexate may be an effective alternative for the treatment of early ectopic pregnancy.     

Oral methotrexate for treatment of ectopic pregnancy

OBJECTIVE: The purpose of this study was to evaluate oral methotrexate tablets in the treatment of ectopic pregnancy. STUDY DESIGN: Patients with a diagnosis of ectopic pregnancy were offered oral methotrexate tablets rather that intramuscular injection. Oral methotrexate was given in 2 divided doses 2 hours apart at a dose of 60 mg/m(2) with standard 2.5 mg methotrexate tablets. Patients were followed up with the use of the same protocol that was used typically for intramuscular methotrexate. RESULTS: Nineteen of 22 patients (86%) were successfully treated. There was no statistical difference between patients who were treated successfully or unsuccessfully, with respect to initial human chorionic gonadotropin titers (P =.55), ectopic size (P =.77), or methotrexate dose (P =.18). Nineteen of 22 patients (86%) had increased pain during treatment. Outside of pain, gastrointestinal side effects were the most common. Thirty-two percent of patients required more than one treatment cycle. CONCLUSION: Oral methotrexate can be used to treat ectopic pregnancy successfully, but there are few advantages to recommend its use over intramuscular methotrexate.     

Single-dose methotrexate for treatment of ectopic pregnancy

Methotrexate treatment of unruptured ectopic pregnancy is safe and effective and preserves reproductive potential. Previous protocols have required multiple methotrexate doses with or without citrovorum rescue. The purpose of this study was to determine whether patients with an unruptured ectopic pregnancy 3.5 cm or less in greatest dimension could be treated with single-dose intramuscular methotrexate (50 mg/m2) without citrovorum rescue. Thirty-one patients were eligible for this outpatient treatment protocol. One patient withdrew from follow-up, leaving 30 patients (96.8%) in the study group. Patients had a mean age of 28.5 years (range 18-37) and a mean gravidity of 3.0 (range 1-8); nine of 30 (30%) had previously undergone a salpingectomy for ectopic pregnancy. Pre-treatment hCG titers ranged from 130-16,700 mIU/mL (mean 4558). Pre-treatment transvaginal sonography visualized the ectopic in 28 of 30 patients (93.3%) and revealed cardiac activity in six patients. Patients were monitored with hCG titers three times per week for the first week, and then weekly until the hCG was less than 15 mIU/mL. A complete blood count and liver enzymes were obtained before treatment and on day 7. All patients had a continued rise in hCG titer for at least 3 days after methotrexate injection, although all levels began to decline by day 7. No patient required a second dose of methotrexate and no patient experienced any side effects. Twenty-nine of 30 patients (96.7%) were successfully treated. Six of 30 (20%) experienced an increase in lower abdominal pain between days 5-10, and two were hospitalized overnight for observation.(ABSTRACT TRUNCATED AT 250 WORDS)     

Prognostic value of human chorionic gonadotropin changes after methotrexate injection for ectopic pregnancy

Because early prediction of clinical outcome (one or more injections or surgery) of methotrexate treatment of ectopic pregnancy could ease the intensity of follow-up and patient compliance required, we studied the relationship between the change in hCG levels after methotrexate injection and outcome in 129 consecutive patients. A 20% decline in hCG levels between days 1 and 4 during methotrexate treatment has a positive predictive value of 97%.     

Lack of resolution of ectopic pregnancy by intratubal injection of methotrexate.

Although reports of local injection of MTX in the treatment of EP appeared to be promising, our results do not confirm the efficacy of this approach. Our experience was sufficiently discouraging to prompt discontinuation of a randomized trail; our hope is that others will add to the accumulating data base so that the role of local injection of MTX can be clarified.     

Plasma creatine phosphokinase level may predict successful treatment after a single injection of methotrexate for ectopic pregnancy

Our finding that creatine phosphokinase level was significantly higher in women successfully treated for ectopic pregnancy with only a single injection of methotrexate suggests that this indicator predicts this outcome.     

Transvaginal intratubal methotrexate treatment of ectopic pregnancy.

OBJECTIVE: To evaluate the efficacy of transvaginal intratubal methotrexate (MTX) treatment of tubal ectopic pregnancy (EP). SETTING: Outpatient setting in University Hospital. PATIENTS: Forty women with early EP and rising serum beta-human chorionic gonadotropin (beta-hCG) levels. INTERVENTION: Transvaginal intratubal administration of MTX (1 mg/kg body weight). MAIN OUTCOME MEASURES: Success was defined as declining serum beta-hCG to undetectable levels, no tubal dilatation on ultrasound examination, and no further intervention was required. RESULTS: Treatment was associated with a 70% success rate. No difference was found in the success rate between women with an embryo (76.9%) and those with no embryo in their fallopian tubes (66.7%). The initial serum beta-hCG levels were also not different between patients who were successfully treated and those who failed to respond to the treatment. Despite declining serum beta-hCG levels, tubal rupture occurred in two patients. CONCLUSIONS: Treatment of EP by transvaginal MTX administration is associated with a 70% success rate. This is independent of the presence of an embryo or the initial serum beta-hCG levels. Rupture of EP can still occur despite low and declining serum beta-hCG levels.     

Predictors of methotrexate treatment failure in ectopic pregnancy

OBJECTIVE: To determine the possible predictors of methotrexate treatment failure in ectopic pregnancy. STUDY DESIGN: Fifty-eight patients diagnosed with ectopic pregnancy were treated with methotrexate (50 mg/m2). Selected variables in the history of the patients, the signs and symptoms at the time of admission, transvaginal ultrasound findings and serum beta-human chorionic gonadotropin (beta-hCG) levels on day 1 and 3 were evaluated in a logistic regression model to predict treatmentfailure, defined as tubal rupture. RESULTS: Methotrexate treatment failed in 9 cases (15.5 %). Another 9 cases (15.5%) required a second dose of methotrexate, and no treatment failures were observed in these cases. The presence of subchorionic tubal hematoma in the ectopic gestation (OR = 22.9, CI = 2.7-194.7, p = 0.004), the presence of an embryo (OR = 24, CI = 2.1-269, p = 0.01) and day 1 serum beta-hCG level > or = 3,000 mIU/mL (OR = 27.1, CI = 2.1-342.5, p = 0.01) were the main predictors of treatment failure. Follow-up serum beta-hCG levels > or =3,500 mIU/mL (OR = 42.9, CI = 4.3-421) on day 3 were significant predictors of treatment failure. Follow-up risk score was calculated as > 4 on day 3 by adding day 3 serum beta-hCG level to the admission score. Only 1 treatment failure (2.4%) occurred in 42 patients with an admission score of nil. No treatment failure occurred in 39 patients whose follow-up score was nil. The increase in admission risk (OR = 32.1, CI = 3.8-270, p = 0.001) and follow-up risk (OR = 9.2, CI = 2.4-35.2) were significant predictors of treatment failure. CONCLUSION: Transvaginal ultrasound findings are as important as serum beta-hCG level on the first day of methotrexate treatment. In unruptured cases, day 3 serum beta-hCG level is important to reevaluate the decision to continuefollow-up or perform early surgery for increased risk of treatment failure.     

Conservative treatment of ectopic pregnancy by means of a single injection of methotrexate into the gestational sac

The authors treated an ectopic pregnancy with a single dose of MTX injected into the gestational sac. With the resolution of the clinical symptoms, a complete "restitutio ad integrum" was obtained.     

米非司酮联合甲氨蝶呤治疗异位妊娠

目的 探讨米非司酮联合甲氨蝶呤治疗异位妊娠的效果。方法 78例输卵管妊娠患者随机分为A、B两组，A组42例给予米非司酮，3次／d，口服，每次50mg，连续3天，同时给予甲氨蝶呤60mg一次性肌肉注射。B组36例，给予甲氨蝶呤60mg一次性肌肉注射。定期检测血β—HCG、血常规、肝、肾、凝血功能、B超。结果 米非司酮联合甲氨蝶呤治疗异位妊娠成功率为88．09％，明显高于对照组。治疗效果与用药方案及治疗前血β—HCG水平有关。结论 米非司酮联合甲氨蝶呤治疗异位妊娠安全有效，早期诊断、严格掌握适应证是治疗成功的关键。