Combined Chemotherapy in the Medical Management of Tlibal Pregnancy

EDITORIAL COMMENT: We accepted this paper for publication because the regimen for medical management of tubal pregnancy by the systemic route with such small doses of methotrexate and prostaglandin seems much simpler than laparoscopic injection into the tubal pregnancy. The authors have been cautious with the management of these patients keeping them in hospital for a week after therapy. If this period of hospitalization is necessary then it distracts from the value of the method. It is difficult to see why hospitalization is more necessary in patients treated systemically than those reported by other authors where the methotrexate was introduced into the gestation sac under ultrasound control. Summary: The medical management of early unruptured tubal ectopic pregnancies is gaining acceptance internationally as an alternative to surgical procedures. This method has been shown to be effective and safe in properly selected cases and with adequate supervision. Most of the work however has been done using either methotrexate or prostaglandins. The present study aimed to evaluate the efficacy of a combined therapeutic regimen. The efficacy was noted to be at least as good but with fewer side‐effects. The treatment was effective in 18 out of 19 cases of tubal pregnancies (94.7%). One patient complained of a gastritis which resolved with antacids. One patient experienced abdominal cramps and transient hypotension probably as a profound vagal response during tubal abortion. The median time to resolution varied directly with the initial serum beta HCG level at diagnosis. All patients who responded to die therapy described the experience as painless and viewed die treatment positively as it spared diem the need for surgery and its attendant anaestiietic risks. However, we strongly recommend caution and close supervision and to keep the patient in the hospital at least for the first week of dierapy.