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Re: ectopic pregnancies and IM methotrexateFrom: Thomas Ind (100333.1216@compuserve.com)Wed Dec 23 23:41:32 1998
I use Methotrexate but would not use it in a symptomatic woman or a woman with an extopic of 4cm or more such as that you describe. The only reason is that I haven't seen evidence to date that says it is safe. I am keeping an eye out though as I have had great success with methotrexate to date. I haven't opened an ectopic for a long time. I have even managed to deal with a number of ruptured ectopics laparoscopically but none were on deaths door even though I took out about 2 litres of blood in one case (good anaesthetists perhaps?). I regularly perform a salpingectomy. The argument is simple. Salpingostomy does not improve future fecundity by dramatically increases the risk of another ectopic. I tend to discuss it with the patient before the laparoscopy. I also explain that no good randomised studies have been done and go into it at some length. Many women chose to have a salpingostomy if appropriate, other chose to have a salpingectomy rather than a salpingostomy if the other tube is macroscopically normal (even though they are aware it might not be microscopically normal). Salpingectomy is also easier laparoscopically. You can normall just cut it out after putting a couple of endoknots around it. (I tie my own as it is cheaper). I use two 5mm ports and place a 5mm scope down one at the end to help me remove the ecoptic through the 10mm porthole using a glove (no expensive endocatches). No diathermy, quick and safe.
-- Dr Thomas Ind MB BS MD MRCOG St George Hospital Kogarah Sydney NSW 2217 AUSTRALIA
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