Premium
Comparison of double‐ and single‐dose methotrexate protocols for treatment of ectopic pregnancy
Author(s) -
Hamed Hossam O.,
Ahmed Salah R.,
Alghasham Abdullah A.
Publication year - 2012
Publication title -
international journal of gynecology and obstetrics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.895
H-Index - 97
eISSN - 1879-3479
pISSN - 0020-7292
DOI - 10.1016/j.ijgo.2011.08.009
Subject(s) - medicine , methotrexate , human chorionic gonadotropin , ectopic pregnancy , adverse effect , gestational sac , gestational age , prospective cohort study , gynecology , pregnancy , obstetrics , urology , surgery , hormone , biology , genetics
Objective To compare efficacy between double‐dose methotrexate and single‐dose methotrexate for treatment of tubal ectopic pregnancy (EP). Methods Between March 2008 and February 2011,157 patients who had tubal EP diagnosed by a non‐laparoscopic approach and were hemodynamically stable were enrolled in a prospective study in Qassim, Saudi Arabia. The participants were randomized to receive either double‐dose (50 mg/m 2 intramuscularly on days 0 and 4; group 1) or single‐dose (50 mg/m 2 intramuscularly on day 0; group 2) methotrexate. Serum human chorionic gonadotropin (β‐hCG) levels were followed until negative. Results The overall success rate was comparable between groups 1 and 2 (88.6% versus 82.0%, P = 0.1). The duration of follow up until negative β‐hCG was shorter in group 1 ( P = 0.001). Receiver operative characteristics showed that higher cut‐off levels of β‐hCG and gestational mass diameter were associated with successful outcome in group 1. Among participants with initial β‐hCG of 3600–5500 mIU/mL, the success rate was higher in group 1 ( P = 0.03). There was no significant difference between groups in adverse effects. Conclusion For treatment of EP, double‐dose methotrexate had efficacy and safety comparable to that of single‐dose methotrexate; it had better success among patients with moderately high β‐hCG and led to a shorter follow up.