Methotrexate useful for managing symptoms in patients with ectopic pregnancy

This study by Sarah Almutairy and team was aimed at investigating the success rate of MTX treatment in King Khalid University Hospital (KKUH) and identifying the effect of patients clinical presentation and other factors that can predict and influence therapeutic success of medical treatment in Saudi patients.

This was a retrospective review of 154 cases of ectopic pregnancy treated with methotrexate from January 2011 to December 2020 at King Khalid University Hospital (KKUH). Demographic data, clinical presentation, treatment progress, and outcome and failure rate were collected and analyzed.

154 patients were treated with MTX; of those patients, 25 received more than one dose. The difference between the responses to MTX treatment in symptomatic and asymptomatic individuals was not significant (p = 0:267). 131 (85%) had successful treatment. There were no associations between patient BMI, ectopic mass size, or ectopic mass site, the presence or absence of pelvic fluid on ultrasound at diagnosis, and the treatment success rate. There was a significant decline in the treatment success rate with increasing β-hCG levels on the presentation day (p = 0:035) and on day 4 (p value<0.001) of treatment.

MTX is an effective therapeutic option for ectopic pregnancy. However, timely detection is a prerequisite for the success of MTX treatment. High-risk individuals, such as those with a history of abortion and pelvic surgery, should be continuously monitored for signs of ectopic pregnancy to ensure early diagnosis. Furthermore, the outcome of medical treatment is not affected by the patients presenting symptoms.

MTX treatment success rate was not affected by patient clinical presentation, the treatment efficacy in patients typically presenting with abdominal pain and asymptomatic patients is similar. In patients with initial β-hCG or day 4 β-hCG post treatment levels >5000 IU/L failure rate is higher and 2- dose regimen seems a better option.

Source: Sarah Almutairy and Lateefa Othman Aldakhil; Hindawi Journal of Pregnancy Volume 2022, Article ID 5778321, 6 pages https://doi.org/10.1155/2022/5778321