Marianne Koch1,2, Stephanie Schwab3, Elias Meyer4, Eliana Montanari1, Yvonne Bader1, Johannes Ott1, Samir Helmy1,2. 1. Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria. 2. Karl Landsteiner Society, St. Pölten, Austria. 3. Department of Obstetrics and Gynecology, St. Joseph Hospital, Vienna, Austria. 4. Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria.
Abstract
INTRODUCTION: The aim of this study was to compare ultrasound-guided local methotrexate (MTX) vs. systemic methotrexate in uterine ectopic pregnancy regarding the beta human chorionic gonadotropin (hCG) clearance duration. MATERIAL AND METHODS: Patients with interstitial pregnancy, cervical pregnancy or cesarean scar pregnancy were included. Methotrexate was administered locally ultrasound-guided (25 mg methotrexate fixed dose) or systemically (intramuscular; 50 mg/m2 body weight). Beta hCG clearance duration in days formed the main outcome measure. RESULTS: Forty-six patients with uterine ectopic pregnancy were included. The mean estimated beta hCG clearance duration was 29.2 days longer in patients with local methotrexate compared with systemic methotrexate (64.7 vs. 31.5 days, respectively; p = 0.026). There was no significant difference between local vs. systemic methotrexate regarding adverse events such as bleeding (p = 0.376), pain (p = 0.146) or secondary surgery (p = 0.631). There was no association of initial beta hCG levels (p = 0.746), initial progesterone levels (p = 0.870) or patients' age (p = 0.604) and the beta hCG clearance duration. No significant difference in beta hCG clearance duration comparing local methotrexate injection with aspiration vs. local methotrexate injection without aspiration could be found (mean 49.4 and 71.6 days, respectively, p = 0.225). CONCLUSIONS: In patients with uterine ectopic pregnancies, the mean estimated beta hCG clearance duration was 29.2 days longer when applying local methotrexate compared with systemic methotrexate.
INTRODUCTION: The aim of this study was to compare ultrasound-guided local methotrexate (MTX) vs. systemic methotrexate in uterine ectopic pregnancy regarding the beta human chorionic gonadotropin (hCG) clearance duration. MATERIAL AND METHODS:Patients with interstitial pregnancy, cervical pregnancy or cesarean scar pregnancy were included. Methotrexate was administered locally ultrasound-guided (25 mg methotrexate fixed dose) or systemically (intramuscular; 50 mg/m2 body weight). Beta hCG clearance duration in days formed the main outcome measure. RESULTS: Forty-six patients with uterine ectopic pregnancy were included. The mean estimated beta hCG clearance duration was 29.2 days longer in patients with local methotrexate compared with systemic methotrexate (64.7 vs. 31.5 days, respectively; p = 0.026). There was no significant difference between local vs. systemic methotrexate regarding adverse events such as bleeding (p = 0.376), pain (p = 0.146) or secondary surgery (p = 0.631). There was no association of initial beta hCG levels (p = 0.746), initial progesterone levels (p = 0.870) or patients' age (p = 0.604) and the beta hCG clearance duration. No significant difference in beta hCG clearance duration comparing local methotrexate injection with aspiration vs. local methotrexate injection without aspiration could be found (mean 49.4 and 71.6 days, respectively, p = 0.225). CONCLUSIONS: In patients with uterine ectopic pregnancies, the mean estimated beta hCG clearance duration was 29.2 days longer when applying local methotrexate compared with systemic methotrexate.