Management of uterine ectopic pregnancy – local vs. systemic methotrexate. (21st April 2018)

• Record Type: Journal Article
• Authors: Koch, Marianne; Schwab, Stephanie; Meyer, Elias; Montanari, Eliana; Bader, Yvonne; Ott, Johannes; Helmy, Samir
• Is Part Of: Acta obstetricia et gynecologica Scandinavica. Volume 97:Number 7(2018)
• Page Start: 824
• Page End: 829
• Publication Date: 2018-04-21
• Subjects: Methotrexate -- uterine ectopic pregnancies -- cervical pregnancy -- interstitial pregnancy -- cesarean section scar pregnancy -- beta hCG clearance duration; Gynecology -- Periodicals; Pregnancy -- Periodicals; Obstetrics -- Periodicals; 618.05
• DOI: 10.1111/aogs.13348
• Languages: English
• ISSNs: 0001-6349

Abstract

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/m 2 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.