methotrexate / ectopic pregnancy
From: Latha Natarajan (nattu@bgl.vsnl.net.in)
Thu Nov 14 11:39:06 2002
Arch Gynecol Obstet 2001 May;265(2):82-4 Related Articles, Links
Methotrexate versus hyperosomolar glucose in the treatment of extrauterine pregnancy.
Sadan O, Ginath S, Debby A, Rotmensch S, Golan A, Zakut H, Glezerman M.
Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Sackler Faculty of Medicine, Tel Aviv University, Israel.
The aim of this prospective, randomized, double blind study was to compare the efficacy of methotrexate and hyperosmolar glucose injected directly into the extra-uterine gestational sac under laparoscopic vision. The study included twenty women with ectopic pregnancy.
Inclusion criteria were intact tubal pregnancy, not exceeding 4 cm in diameter, rising or plateauing betahCG levels, and no evidence of intra-abdominal bleeding.
The patients were treated by laparoscopically guided injection of 3 mL fluid into the area containing the tubal pregnancy. The fluid contained either 25 mg methotrexate (n=9) or 50% glucose (n=9). Daily decrease in betahCG levels was faster in patients treated by methotrexate (median 8.7%) than in those treated by hyperosmolar glucose (median 4.8%), p=0.17. The study was discontinued due to a higher failure rate in the group treated by hyperosmolar glucose. In conclusion, local injection of methotrexate is superior to hyperosmolar glucose. It can be used as an alternative to salpingostomy or salpingotomy whenever laparoscopy is performed for the diagnosis and treatment of extra-uterine pregnancy.
Publication Types:
a.. Clinical Trial
b.. Randomized Controlled Trial
PMID: 11409480 [PubMed - indexed for MEDLINE]
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: Am J Obstet Gynecol 2002 Jun;186(6):1192-5
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Oral methotrexate for treatment of ectopic pregnancy.
Lipscomb GH, Meyer NL, Flynn DE, Peterson M, Ling FW.
Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis, USA.
OBJECTIVE: The purpose of this study was to evaluate oral methotrexate tablets in the treatment of ectopic pregnancy. STUDY DESIGN: Patients with a diagnosis of ectopic pregnancy were offered oral methotrexate tablets rather that intramuscular injection. Oral methotrexate was given in 2 divided doses 2 hours apart at a dose of 60 mg/m(2) with standard 2.5 mg methotrexate tablets. Patients were followed up with the use of the same protocol that was used typically for intramuscular methotrexate. RESULTS: Nineteen of 22 patients (86%) were successfully treated. There was no statistical difference between patients who were treated successfully or unsuccessfully, with respect to initial human chorionic gonadotropin titers (P =.55), ectopic size (P =.77), or methotrexate dose (P =.18). Nineteen of 22 patients (86%) had increased pain during treatment. Outside of pain, gastrointestinal side effects were the most common. Thirty-two percent of patients required more than one treatment cycle. CONCLUSION: Oral methotrexate can be used to treat ectopic pregnancy successfully, but there are few advantages to recommend its use over intramuscular methotrexate.
PMID: 12066097 [PubMed - indexed for MEDLINE]
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------------------------------------------------------------------------- West Afr J Med 2001 Jul-Sep;20(3):181-3 Related Articles, Links
Medical treatment of ectopic pregnancy using parental methotrexate.
Ekele BA.
Department of Obstetrics and Gynaecology, Usman Dan Fodio University Teaching Hospital, Sokoto.
Between January and December 1999, we were able to diagnose five cases of unruptured ectopic pregnancy, using a transabdominal convex sector transducer. All the five patients presented with lower abdominal pains but were in stable clinical state. They were treated with two doses of 50mg methotrexate intravenously, 48 hours apart. Four of the patients had clinical, immunological, and sonographic evidence of resolution. The only failure was in the patient whose gestation sac was 4.8cm in its maximal diameter. She eventually had laparotomy and salpingectomy.
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------------------------------------------------------------------------- J Reprod Med 2002 Feb;47(2):144-50 Related Articles, Links
Intramuscular methotrexate for tubal pregnancy.
el-Lamie IK, Shehata NA, Kamel HA.
Department of Obstetrics and Gynecology, Ain Shams University, Cairo, Egypt.
OBJECTIVE: To evaluate the safety, convenience and effectiveness of medical treatment of hemodynamically stable tubal pregnancy using intramuscular methotrexate even with adnexal masses up to 5 cm in diameter. STUDY DESIGN: A prospective, observational study was performed on patients admitted with hemodynamically stable tubal pregnancy to the Fourth Unit, Department of Obstetrics and Gynecology, Ain Shams University Maternity Hospital, from September 1999 to August 2000, and fulfilling the inclusion and exclusion criteria. All were given intramuscular methotrexate, 50 mg/m2. RESULTS: Thirty-five (66.04%) of 53 patients admitted with tubal pregnancy were eligible for the study. Seventeen patients (48.5%) had an adnexal mass 3.6-5.0 cm in diameter by transvaginal ultrasonography. Thirty-three patients (94.3%) were cured, with 25 (75.8%) requiring a single dose of methotrexate, 7 (21.2%) two doses and 1 (3%) three doses. Two treatment failures (5.7%) occurred, and both had an adnexal mass > 3.5 cm. The mean time for the hCG level to return to normal was 34.8 days (range, 15-70). Of the 33 patients cured, 20 (60.6%) were treated on an outpatient basis, 7 (21.2%) needed brief readmission due to severe separation pain, and 6 (18.2%) were hospitalized for logistic reasons. There was a large statistically significant difference in the serum hCG level when a cutoff level of 1,000 mIU/mL was used to compare those with an adnexal mass < or = 3.5 cm and those with a mass 3.6-5.0 cm as well as those needing more than one dose and those needing one (P < .001). Similarly, there was a statistically significant difference in the number of doses needed between those with an adnexal mass < or = 3.5 cm and those with a mass 3.6-5.0 cm (P < .05). However, multivariate analysis failed to show any statistically significant relation between treatment failure, hCG level, mass size, gestational age, or number of doses due to small sample size and limited number of events. CONCLUSION: Intramuscular methotrexate for hemodynamically stable tubal pregnancy, even in cases with adnexal masses up to 5 cm in diameter, is safe and effective. Larger trials are needed to validate this approach.
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------------------------------------------------------------------------- Eur J Obstet Gynecol Reprod Biol 2002 Jan 10;100(2):227-30 Related =
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Human chorionic gonadotropin patterns after a single dose of methotrexate for ectopic pregnancy.
Natale A, Busacca M, Candiani M, Gruft L, Izzo S, Felicetta I, Vignali M.
II Department of Obstetrics and Gynecology, Centro Universitario di Chirurgia Endoscopica e Sperimentazione Clinica (CUCESC), University of Milan, Milan, Italy. dott.natale@mailto.it
OBJECTIVE: The great variability in human chorionic gonadotropin (HCG) levels after a single dose of methotrexate (MTX) for ectopic pregnancy makes it difficult to predict treatment failure. We describe different patterns of HCG levels. STUDY DESIGN: Fifty patients were injected i.m. with 50mg/m(2) of MTX for an ectopic pregnancy. Venous blood samples for HCG detection were obtained on the day of treatment (day 0), day 3 and day 7 and weekly until values were undetectable. Patients were classified as: group 1, persistent pathology (n); group 2, complete resolution with a decrease of HCG levels at day 3 (n0); group 3, complete resolution after a rise of HCG values at day 3 (n=9). Statistical analysis was performed using the Mann-Whitney non-parametric test with 95% confidence intervals. RESULTS: Values of day 0 were similar for all the groups. HCG levels of group 3 decreased rapidly after day 3 and at day 7 they were significantly different from levels of group 1. Differences in HCG levels between groups 2 and 3 became indistinguishable from day 21. CONCLUSION: The observation of patients undergoing resolution after an initial increase of HCG levels justify an expectant management for 1 week in clinically stable patients. The strategy to separate HCG curves in patients undergoing resolution may shed light on the different clinical responses to therapy for ectopic pregnancies. However, the phenomenon of the immediate rise of HCG should be better investigated.
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------------------------------------------------------------------------- Acta Obstet Gynecol Scand 2001 Aug;80(8):744-9 Related Articles, Links
Clinical and pregnancy outcome following ectopic pregnancy; a prospective study comparing expectancy, surgery and systemic methotrexate treatment.
Olofsson JI, Poromaa IS, Ottander U, Kjellberg L, Damber MG.
Department of Clinical Science, Obstetrics and Gynecology, Umea University Hospital, S-901 85 Umea, Sweden. jan.olofsson@obstgyn.umu.se
BACKGROUND: The improved possibility of an early diagnosis of ectopic pregnancy by use of serial quantitative beta-subunit human chorionic gonadotropin hormone levels together with transvaginal ultrasound has opened up options for conservative treatment. Systemic methotrexate treatment of unruptured ectopic pregnancy has emerged as a safe and effective alternative to surgical procedures. The aim of the present study was to investigate the effectiveness of methotrexate treatment in routine clinical practice, but also to assess pregnancy outcome during a 2.5-year follow-up period. METHODS: All patients presenting to the Department of Obstetrics and Gynecology, Umea University Hospital, with signs and symptoms of ectopic pregnancy between January 1, 1995 and December 31, 1997 were included in this prospective study. Patients with ectopic pregnancy were either managed expectantly, treated with methotrexate or by laparoscopic or open surgery (salpingostomy/salpingectomy). Systemic methotrexate (Pharmacia & Upjohn, Stockholm, Sweden) was administered as an intramuscular injection of 50 mg/m(2). RESULTS: One hundred and seven patients presented with signs and symptoms of a possible ectopic pregnancy, of these 89 patients eventually were diagnosed as having an ectopic pregnancy. Twenty-six (29%) patients were treated with methotrexate, 46 (52%) patients with laparoscopy or laparotomy, and 17 (19%) patients by expectant management. Success rate in the methotrexate group, after one or more injections, was 77% (20 patients out of 26). The mean time to resolution was 24+/-9 days. There was no difference in pregnancy rate following methotrexate treatment compared to surgical treatment. CONCLUSIONS: Systemic single-dose methotrexate treatment is a safe treatment option with a reasonably high success rate, with similar probability of a later intrauterine pregnancy as conventional surgical treatment.
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