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Re: ectopic pregnancies and IM methotrexate From: Efrain Ramirez MD (eramirez@icepr.com) Thu Dec 24 08:17:14 1998 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Tiger Engle: "Re: ectopic pregnancies and IM methotrexate" Previous message: Luis Sanchez-Ramos, M.D.: "Re: fatal shoulder dystocia" In reply to: Peter Wein: "Re: ectopic pregnancies and IM methotrexate" I am a strong advocate for medical treament. As I understand it the success rate is between 67-100% with a median of 84 %. A 10% failure rate is a VERY acceptable one. My experience is that there are very few side effetcs. In the worst case scenario you can always go ahead and do a salpingostomy. The ectopics I am seen now are very "different" from a few years ago. The availability of sensitive hCG tests and patient education makes the difference. At Thu, 24 Dec 1998, Peter Wein wrote: > >At 00:43 24/12/98 -0600, you wrote: >>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 am surprised that you do Tom - the pooled data show that methotrexate is >associated with a failure rate (subsequent rupture) of 10%, as well as 24% >chance of side effects. There have been deaths associated with its use. >Single dose treatment has a resolution rate of 71%, 1 or 2 does a >resolution rate of 84%. Would find it hard to get informed consent to >treatment with as high a failure rate as this if there is a treatment with >(as you say) a low moribidity and 100% success rate! > >Ref: >Parker J, Bisits A, Proietto AM. A systematic review of single-dose >intramuscular methotrexate for the treatment of ectopic pregnancy. Aust NZ >J Obstet Gynaecol 1998; 38: 145 - 150. >Peter Wein -- Efrain Ramirez MD FACOG Next message: Tiger Engle: "Re: ectopic pregnancies and IM methotrexate" Previous message: Luis Sanchez-Ramos, M.D.: "Re: fatal shoulder dystocia" In reply to: Peter Wein: "Re: ectopic pregnancies and IM methotrexate"

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