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Treatment of ectopic pregnancy by systemic methotrexate, transvaginal methotrexate, and operative laparoscopy.

OBJECTIVE
To evaluate the efficacy of treatment of ectopic pregnancy by local administration of methotrexate, systemic methotrexate, and laparoscopy.


METHODS
This study was a retrospective analysis from the department of Obstetrics and Gynecology of two university-affiliated hospitals. Medical records of 40 patients who were treated by methotrexate from January 1991 to October 1994 and 66 patients who were treated surgically by laparoscopy from April 1986 to June 1994 were reviewed. Among the methotrexate group, 19 patients were treated by ultrasound-guided injection and 31 others were treated by intramuscular administration. Success rate of the primary treatment and the duration of hospitalization were examined for each group. The cases of methotrexate failure were characterized and compared with the primary laparoscopic group.


RESULTS
The success rate was similar between the local (79.8%) and the systemic (66.7%) methotrexate groups. The primary laparoscopy group had a significantly higher success rate (95.5%) than the methotrexate group (72.5%); P < .01. When patients who had laparoscopy as their primary treatment (n = 66) were compared with those who underwent surgery after failed methotrexate treatment (n = 11), the primary laparoscopic group were seen to have shorter hospitalization time, smaller tubal diameter at surgery, and higher pre-operative hemoglobin level (P < .05). More patients in the methotrexate failure group (45.5%) had hemoperitoneum of > 500 mL than those in the primary laparoscopy group (1.5%; P < .001).


CONCLUSIONS
There is no difference in efficacy between local and systemic methotrexate administration. Laparoscopic treatment of ectopic pregnancy is associated with a higher success rate than methotrexate treatment. Patients treated by laparoscopy after methotrexate failure were sicker than those who were treated by laparoscopy as their primary treatment.