Single-dose systemic methotrexate for the treatment of persistent ectopic pregnancy after conservative surgery.

Abstract

To determine whether a single outpatient methotrexate injection successfully treats persistent ectopic pregnancy. Nineteen consecutive patients with increasing beta-hCG titers after conservative surgery for ectopic pregnancy were treated with a single intramuscular methotrexate (50 mg/m2) injection. All 19 patients had resolution of their beta-hCG titers without subsequent surgery. Beta-hCG levels commonly increased during the first 3 days after treatment, but subsequently declined. Two patients required hospital admission for observation and analgesia. One of these two patients had probable self-limited intra-abdominal bleeding and required a blood transfusion. A single methotrexate injection is a safe and successful treatment for persistent ectopic pregnancy. Delayed hemorrhage may be a rare complication, and close surveillance is necessary.