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Medical Treatment of Ectopic Pregnancy: A Ten-Year Review of 106 Cases at Maharaj Nakorn Chiang Mai Hospital

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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