Local injection of methotrexate dissolved in saline versus methotrexate suspensions for the conservative treatment of ectopic pregnancy

To compare the local injection of methotrexate (MTX) dissolvedin saline and MTX suspensions for the laparo-scopic treatmentof ectopic pregnancy in terms of success rate and postoperativetubal patency. A total of 26 patients with unruptured ectopicpregnancies were selected from among 60 women with ectopic pregnanciesadmitted to the Nagasaki University clinic. Of these patients,12 were treated with MTX dissolved in saline solution (solutiongroup) and 14 with MTX suspensions consisting of lipiodol (LPD)with phosphatidylcholine (PC) added as a dispersing stabilizer(suspension group). Except for one case treated under transvaginalguidance, all the patients were treated by laparoscopy. Persistentectopic pregnancy was recognized in seven cases (58%) in thesolution group but in only two cases (14%) in the suspensiongroup. Moreover, rupture occurred in two cases in the solutiongroup but in no case in the suspension group. A patent treatedtube was found in seven of 10 cases in the saline group andin 10 of 12 cases in the suspension group. During the follow-upperiod of 6–31 months, five women in the saline groupand three women in the suspension group had an intrauterinepregnancy. In this study, the local injection of MTX is consideredto be a reasonable method for the treatment of unruptured ectopicpregnancy, and the MTX suspension seems to be more effectiveand useful than MTX solution.