Comparison of two different protocols of methotrexate therapy in medical management of ectopic pregnancy

Abstract EN

Background : Ectopic pregnancy (EP) is one of the most dangerous complications of pregnancy and without prompt diagnosis and treatment, it could become a major cause of maternal morbidity and mortality.

Objectives : In this randomized controlled study, we compared single and double dose of methotrexate (MTX) therapy in the treatment of ectopic pregnancy.

Patients and Methods: This study was performed on 76 patients who were admitted to Obstetrics Ward with primary diagnosis of ectopic pregnancy based on their medical history, physical examination, beta subunit (β-HCG) level, and transvaginal ultrasonography.

Using random block allocation, the patients were classified in two groups of single dose and double dose administration of MTX.

In single dose group, 50 mg/m2 of MTX was given at day 0 and in double dose group, the patients received two doses of MTX at day 0 and 4.

The level of β-HCG was measured at day 0, 4, 7 in both groups.

The successful treatment was defined as 15 % reduction in β-HCG level between day 4 and 7.

The two groups were compared with each other with regard to their need for operation, or extra dose of MTX; duration of hospitalization; and MTX complications.

Results: Results showed that the rate of success in double dose method was more than single dose one (79 % versus 69 %) but the difference was not significant (P = 0.29).

Although the need for operation and extra dose of MTX were lower in the double dose group (15.8 % vs.

18.8 % and 5.26 % vs.

13.2 %, respectively), these differences were not significant too.

Duration of hospitalization was significantly lower in double dose compared to the single dose (11.55 d vs.

14.76 d, P < 0.001).

Conclusions : Single dose therapy of MTX has sufficient power and efficacy in the treatment of ectopic pregnancy, however in patients with higher serum level of β-HCG, the successful treatment increases by using double dose method.

Using double dose also could decrease the necessity of operation, re-administration of MTX, and duration of hospitalization.