Direct Methotrexate Injection into the Gestational Sac for Nontubal Ectopic Pregnancy: A Review of Efficacy and Outcomes from a Single Institution |
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| Institution: | 1. Departments of Anesthesiology and Pain Medicine (Drs. Lee, Park, J. Kim, and Ki);2. Obstetrics and Gynecology (Dr. Cha), CHA Bundang Medical Center, CHA University, Seongnam, Korea;3. Department of Anesthesiology and Pain Medicine (Dr. J. Y. Kim), Ajou University School of Medicine, Suwon, Korea.;1. Department of Gynecological Endocrinology and Reproductive Medicine, Medical University of Vienna, Vienna, Austria (Drs. Ott, Hager, Nouri, Marschalek, and Kurz);2. Department of Obstetrics and Gynecology, Semmelweis Frauenklinik der Krankenanstalt Rudolfstiftung, Vienna, Austria (Dr. Hager).;1. Departments of Minimally Invasive Gynaecologic Surgery (Drs Asgari, Salehi, and Hoseini) and Sonography and Radiology (Dr Abedi), Arash Women''s Hospital, Tehran University of Medical Sciences, Tehran, Iran;2. Health Metrics Research Centre, Institute for Health Sciences Research, Academic Center for Education, Culture and Research, Tehran, Iran (Dr Montazeri);1. Endoscopy Unit, Centro Gutenberg, Malaga, Spain (Dr. Alonso);2. Department of Obstetrics and Gynecology, “Filippo Del Ponte” Hospital, University of Insubria, Varese, Italy (Dr. Laganà);3. Department of Obstetrics, Gynecology and Reproductive Sciences, University of Miami, Miami, Florida (Drs. Palin and Carugno).;1. Endoscopy Unit, Centro Gutenberg, Malaga, Spain (Dr. Alonso);2. Department of Obstetrics and Gynecology, University of Miami Miller School of Medicine, Miami, Florida (Drs. Ulker, Timmons, and Carugno). |
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| Abstract: | Study ObjectiveTo evaluate the efficacy of nontubal ectopic pregnancy (NTEP) management with direct methotrexate (MTX) injection into the gestational sac.DesignA retrospective chart review.SettingA tertiary academic and teaching hospital.PatientsAll cases of confirmed NTEP were retrospectively identified from 2012 to 2017.InterventionsUltrasound-guided direct injection of MTX into the fetal pole and surrounding gestational sac and a single dose of systemic MTX with or without fetal intracardiac injection of potassium chloride.Measurements and Main ResultsTreatment failure, complications from treatment, operating time, and days to negative serum human chorionic gonadotropin (hCG) after treatment were measured. Fourteen women (age 34 ± 5.2 years) with NTEP underwent direct MTX injection (cesarean scar, n = 4; interstitial, n = 6; cervical, n = 4). The mean estimated gestational age was 49 ± 11, CI (43, 56 days). One patient required laparoscopic intervention with a failure rate of 1 of 14 (a double interstitial, heterotopic pregnancy). There were no other major complications. The time in the operating room was similar for all NTEP types. The average time to negative serum hCG was not different for cesarean scar (84.5 ± 36 days), cervical pregnancies (70.5 ± 19 days), or interstitial pregnancies (45.3 ± 38 days, p = .15).ConclusionDirect MTX injection into the gestational sac for NTEP treatment is safe and effective. The failure rate of 7% is considerably lower than what was previously reported for a failure of systemic MTX in similar cases (25%). Resolution of serum hCG after treatment can be quite prolonged even in uncomplicated cases. |
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