Drug-Therapy of Unruptured Ectopic Pregnancy with Methotrexate

Even though the medical sciences have developed increasingly, ectopic pregnancy is still an important cause of maternal mortality. Despite many researches on medical therapy of ectopic pregnancy (EP), surgery is still the first management of patients with EP. Most of these patients have become pregnant for the first time and keeping their fertility in the future is very important. Surgery especially salpangectomy can do nothing to keep this fertility. It seems that efficacy of medical therapy of EP, especially in Iran is unknown. This research was conducted to determine the efficacy of medical therapy of EP with Methotrexate in some patients. In a prospective uncontrolled clinical trial study 26 patients with EP were hospitalized in Yazd Madar hospital. Six of them did not have any indications of medical therapy and were treated surgically.20 patients were treated with Methotrexate considering all the requirements. These patients received Methotrexate 1mg/kg daily. For the prevention of side effects, folinic acid with a dose of 0.1 Methotrexate was given. The efficacy of treatment was determined afterwards with the serial measuring of serum level. The data were analyzed using Chi-Square test and SPSS software. The average age of these patients was 27.19 years and most of them had spotting as a symptom. They had been married for 6.9 years on average and most of these patients (42.3%) were experiencing their first pregnancy. Fourteen patients (53.8%) had a history of infertility and 26.9% had a history of abortion. 50% had experienced a previous abdominal surgery. Four patients had recurrent EP and the average of gestational age at the time of diagnosis was 6.2 weeks. Finally fifteen patients (75%) were treated successfully. Four out of five patients, who had a failed medical treatment, had a serum level higher than 1000 IU/L. Five out of eight patients, (62.5%) who were followed, experienced normal intrauterine pregnancy after one year of treatment. Medical therapy of Ectopic pregnancy with Methotrexate seems to be safe and effective but when serum level exceeds 1000 IU/L it is less likely to succeed.