Publication:

Single dose methotrexate for the treatment of unruptured ectopic pregnancy: experience in Kemaman Hospital, Terengganu, Malaysia

Background The objective of this study was to review our experience with single dose intramuscular methotrexate (MTX) for the treatment of ectopic pregnancy and to evaluate the safety and efficacy of the treatment modality.

Methods A prospective study was carried out at Kemaman Hospital, Terengganu, Malaysia. A database was started and continued prospectively for patients meeting all the criteria’s for MTX therapy from January 2015 till January 2016. The selection criteria’s were patients who were asymptomatic or experience mild symptoms but haemodynamically stable and ectopic gestational mass of less than 4cm on ultrasound. Intramuscular methotrexate (MTX) 50mg/m2 was administered as in-patient and monitored at least 24 hours for side effects. Upon discharge, blood samples were collected on day 4 and day 7 of MTX therapy and weekly to 2-weekly thereafter until hCG titers became < 2mIU/mL.

Results 4 patients opted for medical treatment. All patients received only a single dose methotrexate and did not have complications post medical treatment. hCG level reached normalization within 30 days and 1 patient had longer follow up until 120 days. Higher patient satisfaction in all patients due to the noninvasive nature of the treatment modality.

Conclusions This study showed that medical treatment of ectopic pregnancy with systemic single dose methotrexate can be a primary treatment modality for selected patients with stable unruptured tubal pregnancy.