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A Journal on Obstetrics and Gynecology
Indexed/Abstracted in: EMBASE, PubMed/MEDLINE, Scopus, Emerging Sources Citation Index
Minerva Ginecologica 2003 December;55(6):531-6
Methotrexate treatment for tubal pregnancy. Criteria for medical approach
Cobellis G., Pierno G., Pecori E., Scaffa C., Stradella L., Messalli E. M., Festa B., Cobellis L.
Aim. The purpose of this retrospective study is to underline the indications for the use of systemic methotrexate (MTX) in tubal pregnancies.
Methods. One hundred- and four (n=104) consecutive women were treated in our Department for tubal pregnancy. The database analysis showed that after careful respect for inclusion criteria, the treatment chosen was the intravenous administration of MTX in 68 patients, whereas laparoscopy constituted the primary treatment in 36 patients. A single dose of MTX was intravenously administered, diluted in saline solution, with a dosage of 50 mg/m2 of body surface. Close serum ß-hCG monitoring was performed, and in the case of a short fall, a 2nd dose of methotrexate was submitted.
Results. The overall success rate of MTX treatment was 91%; the 2nd dose of MTX was used in 12% of patients, whereas in only 6 out of 68 patients included in the medical treatment group a surgical approach for suspected tubal rupture was necessary.
Conclusion. Treatment with methotrexate is effective and safe in the presence of these criteria: patient hemodynamically stable, absence of tubal rupture sign and hemoperitoneum, an adnexal mass with a diameter ¾5 cm, an amenorrhea ¾6 weeks and HCG levels ¾10000 mIU/ ml. Laparoscopy is indicated in diagnostic uncertainty, when MTX is not suggested, when adnexal mass is >5 cm, or in patients in which ß-hCG levels was >10000 mIU/ml.