Single high dose of local methotrexate for the management of relatively advanced ectopic pregnancies

Objective: To evaluate the limits of the conservative management of relatively advanced ectopic pregnancies (EPs) with local methotrexate given at a higher than standard dose.

Design: Nonrandomized prospective study.

Setting: A tertiary teaching hospital and an affiliated infertility center.

Patient(s): We treated 118 EPs of up to 56 days’ gestation (8 weeks) regardless of the presence of fetal heart activity, the size of the gestational mass, and the initial β-hCG levels.

Intervention(s): Transvaginal intraamniotic or laparoscopic intratubal injection of 100 mg of methotrexate as a single dose.

Main Outcome Measure(s): β-hCG levels, red and white blood cell count, and liver function tests before and after methotrexate injection, followed by repeat transvaginal color Doppler assessments.

Result(s): Treatment was successful in 105 (88.98%) of the 118 patients included in the study. In 7 of them with persistent fetal cardiac activity after the methotrexate injection, treatment was concluded with a complementary intracardiac injection of 10% KCl. No grade 3 or important clinical, hematologic, or biochemical toxicities occurred.

Conclusion(s): Local administration of a single high dose of methotrexate (100 mg) proved safe and effective in the medical management of relatively advanced and unselected EPs, including cases with fetal heart activity, with high initial β-hCG levels, and with a gestational mass beyond the standard maximum of 3.5 cm. Complementary hypertonic KCl proved to be effective in cases with persistent cardiac activity.