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Single‐dose methotrexate for unruptured ectopic pregnancy
Author(s) -
Lecuru F,
Robin F,
Bernard J.P,
Maizan de Malartic C,
MacCordick C,
Boucaya V,
Taurelle R
Publication year - 1998
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/s0020-7292(98)00038-1
Subject(s) - salpingostomy , methotrexate , medicine , ectopic pregnancy , laparoscopy , surgery , pregnancy , genetics , biology
Objectives: To compare the effectiveness of single‐dose methotrexate (MTX) and laparoscopic salpingostomy in the treatment of unruptured ectopic pregnancy (UEP). Methods: 75 patients entered a prospective non‐randomized study. Thirty‐seven women were submitted to a single‐dose methotrexate (Group 1) and 38 underwent laparoscopic salpingostomy (Group 2). Methotrexate (1 mg/kg) was given intramuscularly on an out‐patient basis if the β‐hCG level was<5000 IU/l and the hematosalpinx diameter was<3 cm and the peritoneal fluid<300 cm 3 on TVS. The follow‐up consisted of serial clinical examinations, β‐hCG assays, liver tests and blood cell counts. Laparoscopic salpingostomy was decided in other cases of UEP or when patients refused or could not comply with the follow‐up. Results: Group 1 patients (91.8%) were cured with 1–3 doses of MTX, the remainder required a laparoscopy. Seventy‐three percent of them were treated on an out‐patient basis. The mean time to resolution of hCG was 26.7 days. The initial β‐hCG level significantly correlated with the necessity of a surgical option and the time to resolution of β‐hCG. Whenever β‐hCG was<3600 IU/l, all patients were cured with a single injection, without hospitalization and with a follow‐up of<27 days. Group 2 patients (81.6%) were cured with laparoscopy and 15.8% required a MTX injection for persistent EP. The mean hospital stay was significantly longer than for those that required the MTX injection (2.7 vs. 0.6; P =0.0001), but the follow‐up was shorter and required significantly less clinical examinations, sonograms and biologic tests. Finally the effectiveness of single‐dose MTX and laparoscopic salpingostomy were similar ( P =0.2, 95% CI of the difference:−0.15–0.04). Conclusions: Single‐dose MTX was as effective as laparoscopy in the treatment of UEP. A rigorous selection of the patients for the treatment option is mandatory to guarantee high success rates, in an out‐patient basis and a short follow‐up.