Uğurlucan, F G İstanbul Üniversitesi İstanbul - Tıp Fakültesi - Kadın Hastalıkları ve Doğum Anabilim Dalı, Turkey , İyibozkurt, A C İstanbul Üniversitesi İstanbul - Tıp Fakültesi - Kadın Hastalıkları ve Doğum Anabilim Dalı, Turkey , Çetin, C Aydıncık Devlet Hastanesi - Kadın Hastalıkları ve Doğum Bölümü, Turkey , Nehir, A İstanbul Üniversitesi - İstanbul Tıp Fakültesi - Kadın Hastalıkları ve Doğum Anabilim Dalı, Turkey , Akhan, S İstanbul Üniversitesi - İstanbul Tıp Fakültesi - Kadın Hastalıkları ve Doğum Anabilim Dalı, Turkey

Methotrexate treatment for ectopic pregnancy: Factors affecting treatment outcome

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Objective: To evaluate factors affecting treatment outcome of patients receiving methotrexate for treatment of ectopic pregnancy.Materials and Methods: Patients who were hospitalized for ectopic pregnancy and received methotrexate from 2005 onwards, were analyzed. Demographic variables, β-hCG values, transvaginal-ultrasonography findings, factors affecting treatment outcome were analyzed.Results: Data of 83 patients were analyzed. Treatment was successful in 65 (78.3%), failed in 18 patients (21.7%), and rupture occurred in 6 of these (7.2%). The mean age was 30.4±5.4. The main presenting symptoms were vaginal bleeding (n=47; 56.6%) and abdominal pain (n= 36; 43.4%). Sonographic findings were extrauterine masses in 66 (79.5%), gestational sac in 9 (10.8%), fetal cardiac activity in 5(6%), and free fluid in the Douglas space in 4 patients (4.8%). The mean diameter of the ectopic mass in treatment success and treatment failure groups was 2.5±1.1cm and 3.0±1.9cm, respectively. The difference was not statistically significant. As the size of the extrauterine mass increased above 30 mm, the failure rate increased. The mean β-hCG on the day of methotrexate in treatment success and treatment failure groups was 2915±3079 mIU/ml and 4519±3834mIU/ml, respectively, which was statistically significant. The failure rate increased as B-hCG increased above 2000 mIU/ml. The mean β-hCG on the day of methotrexate in cases resulting in rupture was 5936±2676 mIU/ml. The difference was not statistically significant. One patient suffered from hepatotoxicity, one from diarrhea, one from mucositis, and one from tinnitus during treatment.Conclusion: Methotrexate is safe for treatment of ectopic pregnancy. Baseline β-hCG and size of the extrauterine mass affect treatment success. As B-hCG increased above 2000 mIU/ml and the size of the extrauterine mass increased above 30 mm, the failure rate increased.

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Ectopic pregnancy , methotrexate , medical treatment

Ege Journal Of Medicine

204