Use of methotrexate in ectopic pregnancy. Results in 55 patients treated

BACKGROUND: The opportunity of conservative therapeutic approaches for the treatment of ectopic pregnancy diagnosed early with the use of transvaginal ultrasound. A number of papers came out in the last 15 years, showing successful medical therapies for ectopic pregnancies using methotrexate (MTX) in particular, an analog of folic acid with particular tropism for the trophoblast. METHODS: In this retrospective study, the results of 55 consecutive cases of tubaric pregnancy, treated by endovenous administration of 50 mg/m2 MTX, are presented. RESULTS: The percent of global success was 91% (50/55 patients). A single dose of MTX was able to resolve the tubaric pregnancy in 48 women (89%), while a second administration was necessary in the other seven cases. The percent of success was complete (100%) in patients with six weeks of amenorrhea; these values drop to 72% in patients with seven-eight weeks of amenorrhea; in fact in 5 patients there was a tubal damage. CONCLUSIONS: The results obtained show the possibility to treat electively with MTX patients with ectopic pregnancy at six weeks of amenorrhea, and with good possibilities to save the tubaric patency. For patients with a longer amenorrhea the therapy with MTX remains alternative.