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Open Access
CC BY 4.0 · Rev Bras Ginecol Obstet 2018; 40(11): 680-685
DOI: 10.1055/s-0038-1675807
Original Article
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Methotrexate Therapy for Ectopic Pregnancies: A Tertiary Center Experience

Ozgur Ozyuncu
1   Division of Perinatology, Department of Obstetrics and Gynecology, Faculty of Medicine at Hacettepe University, Ankara, Turkey
,
Atakan Tanacan
1   Division of Perinatology, Department of Obstetrics and Gynecology, Faculty of Medicine at Hacettepe University, Ankara, Turkey
,
Sinem Ayse Duru
1   Division of Perinatology, Department of Obstetrics and Gynecology, Faculty of Medicine at Hacettepe University, Ankara, Turkey
,
Mehmet Sinan Beksac
1   Division of Perinatology, Department of Obstetrics and Gynecology, Faculty of Medicine at Hacettepe University, Ankara, Turkey
› Author Affiliations
Further Information

Publication History

06 March 2018

20 September 2018

Publication Date:
28 November 2018 (online)

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Abstract

Objective Our aim is to demonstrate the importance of methotrexate (MTX) therapy for the treatment of ectopic pregnancy (EP).

Methods This retrospective study consisted of 99 patients (72 tubal EPs, 20 pregnancies of unknown location (PUL), 4 cesarean section (CS) scar EPs and 3 cervical EPs) treated with MTX.

Results Methotrexate therapy was successful in 68.5% of EPs. There were statistically significant differences between the MTX success and failure groups based on ultrasonographic findings, patient complaints, gestational week and serum human chorionic gonadotropin (hCG) values. The MTX success rates in PUL and tubal pregnancies were 95% and 61.1%, respectively. The MTX success rates in single-dose, two-dose and multi-dose protocol groups were 86.9%, 28.6% and 40%, respectively. All cervical and CS scar ectopic pregnancies were treated successfully with MTX therapy.

Conclusion Methotrexate might be the first-line treatment option for EPs under certain conditions. Physicians must be more cautious in cases with higher hCG values, the presence of abdominal-pelvic pain, the presence of fetal cardiac activity, larger gestational sac (GS) diameters, and more advanced gestational weeks according to the last menstrual period.

Keywords

methotrexate - ectopic pregnancy - medical gynecology - diagnosis

Contributions

Ozgur Ozyuncu made substantial contributions to the conception and design of this study, data collection or analysis, and interpretation of data; he took part in writing of the article or critical review of the intellectual content, and he also took part in final approval of the version to be published. Atakan Tanacan made substantial contributions to the conception and design of the study, data collection or analysis, and interpretation of data; he took part in writing of the article or critical review of the intellectual content, and he also took part in final approval of the version to be published. Sinem Ayse Duru made contributions to data collection, analysis and writing of the manuscript. Mehmet Sinan Beksac made substantial contributions to conception and design, data collection or analysis, and interpretation of data; he took part in writing of the article or critical review of the intellectual content, and he also took part in final approval of the version to be published.