Karnchana Srivichai MD*, Chumnong Uttavichai MD*, Theera Tongsong MD*
Affiliation : * Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai
Objective : To evaluate the effectiveness of single-dose intramuscular methotrexate in the treatment of ectopic
pregnancy at Maharaj Nakorn Chiang Mai Hospital
Materials and Methods : A retrospective review of the patient records was performed on the patients with
diagnosis of ectopic pregnancy and treatment with single-dose methotrexate according to the protocol of
Stovall et al between 1996 and 2005. The successful treatment was defined as no need for surgical interven-
tion.
Results : As many as 96 out of 106 (90.6%) were successfully treated with methotrexate, though four required
a second dose. Pretreatment β-human chorionic gonadotropin (β-hCG) levels were significantly lower in
women who responded to single-dose therapy than either in those who required two doses or who had a
failure of medical management (p < 0.01). The mean pretreatment level of β-hCG was 873 mlU/ml. The median
time to resolution of β-hCG was 21 days. In addition, all cases with failed medical treatment had adnexal
masses larger than 3.5 centimeters in diameter.
Conclusion : In the present series, treatment of ectopic pregnancy with single-dose methotrexate was as high
as 90% successful. Women with a high pretreatment β-hCG level and large sonographic adnexal masses had
a greater probability of requiring either surgical intervention or multiple doses of methotrexate.
Keywords : Ectopic pregnancy, Methotrexate
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