Methotrexate useful for managing symptoms in patients with ectopic pregnancy
Ectopic pregnancy is an acute emergency in obstetrics and gynecology that can be fatal if not diagnosed and treated in a timely manner. The incidence has increased over the last few years due to an uptick in assisted reproductive technology use and the prevalence of pelvic inflammatory diseases. Advances in ultrasound technology and rapid serum hormone assays with high sensitivity have enabled early diagnosis before the presentation of symptoms, thus reducing the risk of tubal rupture and increasing the probability of success with more conservative medical treatments.
Methotrexate (MTX) is a folic acid antagonist that inhibits cell proliferation. MTX prevents cytotrophoblast proliferation in ectopic gestation, leading to the reduced production of beta-human chorionic gonadotropin (β-hCG). The levels of progesterone secreted by the corpus luteum are thus decreased. MTX has been proven to be very effective for treating ectopic pregnancies. The protocols for the management of ectopic pregnancies with MTX include single-dose, 2-dose, and multiple-dose protocols. MTX has been shown to be effective for the treatment of ectopic pregnancy. However, treatment is recommended only for hemodynamically stable patients who present with an adnexal mass and initial β-hCG level in a specific range. However, there is an ongoing debate regarding the management of hemodynamically stable patients with MTX who do not meet the aforementioned criteria but want to avoid surgery. β-hCG levels are also used as prognostic markers after MTX treatment.
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
