Comparison of Single-Dose and Multiple-Dose Systemic Methotrexate Regimen for Ectopic Pregnancy

Document Type : مقاله کوتاه

Authors

1 Assistant Professor, Department of Obstetrics and Gynecology, Emam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran

2 Associate Professor, Department of Obstetrics and Gynecology, Emam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran

3 Resident, Department of Obstetrics and Gynecology, Emam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran

4 Researcher, Kermanshah University of Medical Sciences, Kermanshah, Iran

Abstract

Background: Ectopic pregnancy is a common serious problem with high morbidity percentage and possibility of maternal mortality. Methotrexate, in the patients with unruptured less-than-4-cm ectopic mass, is a proved treatment. We compared single- and multiple-dose systemic methotrexate regimen for ectopic pregnancy.Methods: 120 women who were diagnosed to have ectopic pregnancy via clinical symptoms, ultrasound examination and beta human chorionic gonadotropin (β-hCG) levels were divided to two equal groups. The first were treated with a single dose regimen of intramuscular methotrexate (50 mg/m2) and the second, received 4 doses of 1 mg/kg of intramuscular methotrexate at the days 1, 3, 5, and 7. The serum β-hCG values were measured and compared at the initiation of treatment and 1 week and 1 month after it.Findings: The overall success rate of methotrexate for an ectopic pregnancy was 76% in single-dose and 96.7% in multiple-dose regimens. The rupture of ectopic pregnancy mass during the treatment was less (3.3%) in multiple-dose group compared to the single-dose one (10%).Conclusion: Multiple-dose methotrexate therapy is more effective than single-dose in ectopic pregnancy and is safer, too.

Keywords

References

  1. Cunningham F, Leveno K, Bloom S, Hauth J, Rouse D, Spong C. Williams obstetrics. 23rd ed. New York, NY: McGraw-Hill Professional; 2008.
  2. Fritz MA, Speroff L. Clinical gynecologic endocrinology and infertility. 7th ed. Phlladelphia, PA: Lippincott Williams and Wilkins; 2010.
  3. Berek JS. Novak's gynecology. 13th ed. Philadelphia, PA: Lippincott Williams and Wilkins; 2002.
  4. Gervaise A, Capella-Allouc S, Audibert F, Rongieres-Bertrand C, Vincent Y, Fernandez H. Methotrexate for the treatment of unruptured tubal pregnancy: a prospective nonrandomized study. JSLS 2003; 7(3): 233-8.
  5. Lipscomb GH, Givens VM, Meyer NL, Bran D. Comparison of multidose and single-dose methotrexate protocols for the treatment of ectopic pregnancy. Am J Obstet Gynecol 2005; 192(6): 1844-7.
  6. Dokic MD, Perisic DV. Conservative treatment of ectopic pregnancies: comparison of velocity of decrease of beta-HCG between spontaneous and methotrexate induced resorptions. Srp Arh Celok Lek 2004; 132(5-6): 163-6. [In Serbian].
  7. Lipscomb GH, McCord ML, Stovall TG, Huff G, Portera SG, Ling FW. Predictors of success of methotrexate treatment in women with tubal ectopic pregnancies. N Engl J Med 1999; 341(26): 1974-8.
  8. 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.
  9. Soliman KB, Saleh NM, Omran AA. Safety and efficacy of systemic methotrexate in the treatment of unruptured tubal pregnancy. Saudi Med J 2006; 27(7): 1005-10.
  10. Bixby S, Tello R, Kuligowska E. Presence of a yolk sac on transvaginal sonography is the most reliable predictor of single-dose methotrexate treatment failure in ectopic pregnancy. J Ultrasound Med 2005; 24(5): 591-8.
Journal of Isfahan Medical School
Volume 32, Issue 292 - Serial Number 292
May and June 2014
Pages 1054-1060

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History

  • Receive Date: 16 March 2014
  • Revise Date: 03 May 2024
  • Accept Date: 06 April 2022

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