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[Limits of ambulatory medical treatment of ectopic pregnancies by intramuscular methotrexate: prospective study on 54 patients].

OBJECTIVE
To evaluate the limits of ambulatory treatment of ectopic pregnancy with an intramuscular injection of 50 mg/m2 methotrexate.


METHOD
Non randomised prospective study from october 1993 and april 1996 at Poissy Hospital. 100 ectopic pregnancies were diagnosed: 54 were treated medically and 46 had a surgical treatment.


RESULTS
The mean hCG for the ectopic pregnancies treated medically was 7,273 Ul/ml +/- 12,548 (90-68,220), an ectopic mass was seen in 74% and to precise the diagnosis a currettage was done in 24 cases (44%) if the initial hCG was below 2,000 Ul/ml. The medical treatment was a success for 37 (68.5%) ectopic pregnancies with a mean time of resolution of hCG of 31.9 days +/- 18 (4-90) (with a positive correlation between initial hCG titer and time to resolution of 0.5, p = 0.001). For 15 (27%) patients a second dose of methotrexate was necessary with a 73% success rate and 17 (32%) patients were operated (8 salpingectomies). Sixteen of 20 (80%) demonstrated tubal patency at follow-up hysterosalpingogram and within 7.5 +/- 4 months 26 of 30 (87%) conceived and there was no recurrence of ectopic pregnancy.


CONCLUSIONS
The medical treatment of ectopic pregnancies with methotrexate has its limits. In our series, if we treat ectopic pregnancies without cardiac activity, with a mass below 35 mm and a hCG below 10,000 Ul/ml the success rate is 81%.