Methotrexate Therapy for Ectopic Pregnancies: A Tertiary Center Experience

This retrospective study consisted of 99 patients (72 tubal EPs, 20 pregnancies of unknown location (PUL), 4 cesarean section (CS) scar EPs and 3 cervical EPs) treated with MTX.

Results

Methotrexate therapy was successful in 68.5% of EPs. There were statistically significant differences between the MTX success and failure groups based on ultrasonographic findings, patient complaints, gestational week and serum human chorionic gonadotropin (hCG) values. The MTX success rates in PUL and tubal pregnancies were 95% and 61.1%, respectively. The MTX success rates in single-dose, two-dose and multi-dose protocol groups were 86.9%, 28.6% and 40%, respectively. All cervical and CS scar ectopic pregnancies were treated successfully with MTX therapy.

Conclusion

Methotrexate might be the first-line treatment option for EPs under certain conditions. Physicians must be more cautious in cases with higher hCG values, the presence of abdominal-pelvic pain, the presence of fetal cardiac activity, larger gestational sac (GS) diameters, and more advanced gestational weeks according to the last menstrual period.

Keywords
methotrexate; ectopic pregnancy; medical gynecology; diagnosis

Variables		Cervical EP (n= 3)	Cesarean scar EP (n= 4)
Maternal age (years)		31.00 ± 2.65	31.75 ± 6.70
Gravida		2.67 ± 0.58	2.25 ± 0.96
Parity		1.33 ± 0.58	1.25 ± 0.96
Abortus		0.33 ± 0.58	0.00 ± 0.00
History of previous EP		None	None
Patient's complaint	Vaginal bleeding	3/3 (100%)	3/4 (75%)
Patient's complaint	Abdominal-Pelvic pain	0/3 (0%)	1/4 (25%)
GS diameter (mm)		30.00 ± 13.23	19.00 ± 8.54
Fetal cardiac activity		3/3 (100%)	3/4 (75%)
Gestational week according to the last menstrual period		8 ± 1.00	7.25 ± 0.96
hCG value on the first day (mIU/ml)		46,711.33 ± 40,474.17	49,654.35 ± 41,154.22
hCG value on the fourth day (mIU/ml)		34,783.17 ± 26,851.06	33,650.21 ± 27,854.23
hCG value on the seventh day (mIU/ml)		27,014.75 ± 20,850.24	26,561.23 ± 21,577.19

Variables		MTX success group(n= 63)	MTX failure group(n= 29)	p-values
USG findings	Tubal	44/63 (69.8%)	28/29 (96.5%)	0.08
USG findings	PUL	19/63 (30.2%)	1/29 (3.5%)	0.001
Maternal age (years)		31 (24–42)	31 (26–43)	0.98
Gravida		3 (1–5)	3 (1–5)	0.62
Parity		1 (0–2)	1 (0–2)	0.50
Abortus		1 (0–2)	0 (0–1)	0.37
History of previous EP		8/63 (12.7%)	9/20 (31%)	0.06
Patient's complaint	Vaginal bleeding	52/63 (82.5%)	14/29 (48.3%)	0.001
Patient's complaint	Abdominal-pelvic pain	11/63 (17.5%)	15/29 (51.7%)	0.001
GS diameter (mm)		8 (3–15)	13 (5–20)	0.001
Fetal cardiac activity		1/63 (1.5%)	7/29 (24.1%)	< 0.001
Gestational week according to the last menstrual period		5 (4–8)	7 (4–8)	< 0.001
hCG value on the first day (mIU/ml)		2,400 (100–4,800)	4,200 (216–4,950)	< 0.001
hCG value on the fourth day (mIU/ml)		2,000 (75–4,700)	4,100 (210–4,900)	< 0.001
hCG value on the seventh day (mIU/ml)		841 (12–3,000)	3,850 (340–5,100)	< 0.001
Percentage for median of hCG decline between days 4 and 7		51.12%	7.14%	< 0.001

MTX Group (n)	Success rate
Single-dose (61)	86.9% (53/61)
Two-dose (21)	28.6% (6/21)
Multi-dose (10)	40% (4/10)

Federação Brasileira das Sociedades de Ginecologia e Obstetrícia Av. Brigadeiro Luís Antônio, 3421, sala 903 - Jardim Paulista, 01401-001 São Paulo SP - Brasil, Tel. (55 11) 5573-4919 - Rio de Janeiro - RJ - Brazil
E-mail: editorial.office@febrasgo.org.br

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[1] Address for correspondence Atakan Tanacan, MD, Division of Perinatology, Department of Obstetrics and Gynecology, Faculty of Medicine, Hacettepe University Hospital, Hacettepe District, 06230 Altindag, Ankara (e-mail: atakantanacan@yahoo.com).