Review on oral methotrexate in medical management of ectopic pregnancy: a 2 years experience in hospital Shah Alam
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20193540Keywords:
Ectopic pregnancy, Conservative management in ectopic pregnancy, Oral methotrexate, Stable ectopic pregnancy, Single dose methotrexate, Tubal pregnancyAbstract
Background: The objective of this study is to determine the success rate of oral methotrexate in Hospital Shah Alam for the past 2 years.
Methods: This is a cross-sectional study using secondary data obtained from medical record office in Hospital Shah Alam on patients with ectopic pregnancy. A total of 35 patients who fulfilled the criteria for medical management were selected. They were prescribed with oral methotrexate with the dose of 60 mg given in 3 divided doses every 2 hours using the standard tablet of 2.5mg. Follow up was done at day 4, day 7 and till HCG level achieve less than 20 iu/litre.
Results: 29 patients were successfully treated with oral methotrexate 60 mg (82.8%). Another 6 patients had to undergo laparoscopic surgery with confirmed leaking, ruptured tubal pregnancy. 4 patients needed second dose of Methotrexate due to rising HCG level and all of them were successfully treated after the second dose. The side effects of oral methotrexate were tolerated well by all patients. There are numbers of predictors for success which are the level of HCG <4000 iu/litre, size of mass <4cm, no abdominal pain during early presentation and decrease of HCG level in between day 4 to day 7 after oral methotrexate.
Conclusions: The success rate of oral methotrexate for stable ectopic pregnancy is good making it a suitable option for clinical settings which has no specialised equipment to handle cytotoxic drugs.
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References
Elson CJ, Salim R, Potdar N, Chetty M, Ross JA, Kirk EJ on behalf of the Royal College of Obstetricians and Gynaecologists. Diagnosis and management of ectopic pregnancy. BJOG. 2016;123(13):e15-e55.
Kirk E, Papageorghiou AT, Condous G, Tan L, Bora S, Bourne T. The diagnostic effectiveness of an initial transvaginal scan in detecting ectopic pregnancy. Hum Reprod. 2007;22(11):2824-8.
Condous G, Okaro E, Khalid A, Lu C, Van Huffel S, Timmerman D. et al. The accuracy of transvaginal ultrasonography for the diagnosis of ectopic pregnancy prior to surgery. Human Reproduction, 2005;20(5):1404-9.
Luesley D, Cardozo BP. Obstetrics and gynaecology: An evidence-based text for MRCOG (3rd Edition). London: Hodder Arnold. 2016;685-698.
Murray H. Diagnosis and Treatment of Ectopic Pregnancy. Canadian Med Asso J. 2005;173(8):905-12.
National Collaborating Centre for Women's and Children's Health (UK). Ectopic Pregnancy and Miscarriage: Diagnosis and Initial Management in Early Pregnancy of Ectopic Pregnancy and Miscarriage. London: Royal College of Obstetrics and Gynecology; 2019 April (NICE Clinical Guidelines, No. 126). Available at: https://www.nice.org.uk/guidance/ng126/resources/ectopic-pregnancy-and-miscarriage-diagnosis-and-initial-management-pdf-66141662244037. Accessed on 7th May 2019.
Megan B. Potter, Lisa A. Lepine, Denise J. Jamieson. Predictors of success with methotrexate treatment of tubal ectopic pregnancy at Grady Memorial Hospital. Am J Obstet Gynecol. 2003:188(5):1192-4.
Menon S, Colins J, Barnhart KT. Establishing a human chorionic gonadotropin cutoff to guide methotrexate treatment of ectopic pregnancy: a systematic review. Fertil Steril. 2007;87(3):481-4.
Sowter MC, Farquhar CM, Petrie KJ, Gudex G. A randomised trial comparing single dose systemic methotrexate and laparoscopic surgery for the treatment of unruptured tubal pregnancy. BJOG. 2001;108(2):192-203.
Stika, Catherine S. Methotrexate: the pharmacology behind medical treatment for ectopic pregnancy. Clin Obstet Gynecol. 2012;55(2):433-9.
Li MC, Hertz R, Bergenstal DM. Therapy of Choriocarcinoma and related trophoblastic tumors with folic acid and purine antagonists. New England J Med. 1958;259(2):66-74.
Tanaka T, Hayashi H, Kutsuzawa T. Treatment of interstitial ectopic pregnancy with methotrexate: report of a successful case. Fertil Steril. 1982;37(6):851-2.
Bachman EA, Barnhart K. Medical management of ectopic pregnancy. Clin Obstet Gynecol. 2012;55(2):440-7.
Barnhart KT, Gosman G, Ashby R, Sammel M. The medical management of ectopic pregnancy: a meta-analysis comparing "single dose" and "multidose" regimens. Obstet Gynecol. 2003;101(4):778-84.
Stovall TG, Ling FW, Gray LA Single-dose methotrexate for treatment of ectopic pregnancy. Obstet Gynecol. 1991;77(5):754-7.
Stovall TG, Ling FW Single-dose methotrexate: an expanded clinical trial. Am J Obstet Gynecol. 1993;168(6 Pt 1):1759-62.
Korhonen J, Stenman U, Ylostalo P. Low-dose oral methotrexate with expectant management of ectopic pregnancy. Obstet Gynecol. 1996;88(5):775-8.
Lipscomb G, Meyer NL, Flynn DE, Peterson M, Ling F. Oral methotrexate for treatment of ectopic pregnancy. Am J Obstet Gynecol. 2002;186(6):1192-5.
Trio D, Strobelt N, Picciolo C, Lapinski RH, Ghidini A. Prognostic factors for successful expectant management of ectopic pregnancy. Fertil Steril. 1995;63(3):469-72.
Skubisz MM, Li J, Wallace EM, Tong S. Decline in hCG levels between days 0 and 4 after a single dose of methotrexate for ectopic pregnancy predicts treatment success: a retrospective cohort study. BJOG. 2011;118(13):1665-8.
Jurkovic D, Hillaby K, Woelfer B, Lawrence A, Salim R, Elson CJ. First‐trimester diagnosis and management of pregnancies implanted into the lower uterine segment Cesarean section scar. Ultrasound Obstet Gynecol. 2003;21(3):220-7.
Peng P, Gui T, Liu X, Chen W, Liu Z. Comparative efficacy and safety of local and systemic methotrexate injection in cesarean scar pregnancy. Ther Clin Risk Manag. 2015;11:137-42.