Pankaj Talwar1, K Sandeep2, Nikita Naredi3, B S Duggal4, Tony Jose5. 1. Senior Advisor (Obstetrics & Gynaecology), INHS Asvini, Colaba, Mumbai, India. 2. Classified Specialist (Obstetrics & Gynaecology), ART Centre, Army Hospital (R&R), New Delhi 10, India. 3. Graded Specialist (Obstetrics & Gynaecology), ART Centre, Army Hospital (R&R), New Delhi 10, India. 4. Consultant (Gynaec) & Endoscopic Surgeon, Ruby Hospital, Pune, Maharashtra, India. 5. Classified Specialist (Obstetrics & Gynaecology), Army Hospital (R&R), New Delhi 10, India.
Abstract
BACKGROUND: Medical management of an unruptured ectopic pregnancy with intramuscular methotrexate is a common and cost-effective alternative to surgery. Early diagnosis and timely institution of methotrexate has resulted in a dramatic decline in the morbidity, mortality and financial burden associated with ectopic pregnancy. The objective of our study was to evaluate the efficacy of medical management in a series of patients with unruptured ectopic pregnancy meeting the strict inclusion criteria. METHODS: Multiple dose methotrexate regimen was utilized for the management of the cases. Parenteral methotrexate 1 mg/kg was administered on Day 1, Day 3, Day 5 and Day 7 whereas rescue dose of injection leucovorin 0.1 mg/kg was given on Day 2, Day 4, Day 6 and Day 8. Monitoring for the resolution of the ectopic was carried out with β-hCG, done on Day 1, Day 3, Day 5, and Day 7. Any value showing a decline of >15% of the baseline value led to the termination of treatment and only surveillance was carried out. If the decrease was <15%, treatment was continued. RESULTS: Total 43 patients with ectopic pregnancy were diagnosed over a period of 1 year, conceived during infertility evaluation and treatment. 11 cases went directly for surgery whereas 32 were subjected to medical treatment. 75% of the patients got successfully treated and rest 25% required surgery following failed medical management. CONCLUSIONS: Methotrexate therapy is a safe and effective alternative for the management of unruptured ectopic pregnancies with minimal or no side-effects and associated advantage of avoiding invasive surgery.
BACKGROUND: Medical management of an unruptured ectopic pregnancy with intramuscular methotrexate is a common and cost-effective alternative to surgery. Early diagnosis and timely institution of methotrexate has resulted in a dramatic decline in the morbidity, mortality and financial burden associated with ectopic pregnancy. The objective of our study was to evaluate the efficacy of medical management in a series of patients with unruptured ectopic pregnancy meeting the strict inclusion criteria. METHODS: Multiple dose methotrexate regimen was utilized for the management of the cases. Parenteral methotrexate 1 mg/kg was administered on Day 1, Day 3, Day 5 and Day 7 whereas rescue dose of injection leucovorin 0.1 mg/kg was given on Day 2, Day 4, Day 6 and Day 8. Monitoring for the resolution of the ectopic was carried out with β-hCG, done on Day 1, Day 3, Day 5, and Day 7. Any value showing a decline of >15% of the baseline value led to the termination of treatment and only surveillance was carried out. If the decrease was <15%, treatment was continued. RESULTS: Total 43 patients with ectopic pregnancy were diagnosed over a period of 1 year, conceived during infertility evaluation and treatment. 11 cases went directly for surgery whereas 32 were subjected to medical treatment. 75% of the patients got successfully treated and rest 25% required surgery following failed medical management. CONCLUSIONS:Methotrexate therapy is a safe and effective alternative for the management of unruptured ectopic pregnancies with minimal or no side-effects and associated advantage of avoiding invasive surgery.
Entities:
Keywords:
Ectopic pregnancy; Medical management; Methotrexate