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Treating Persistent Ectopic Pregnancy by Methotrexate Using a Sliding Scale: Preliminary Experience

Sauer, Mark V.; Vidali, Andrea; James, Walter

To assess the clinical utility of prescribing a sliding scale regimen for methotrexate administered in cases of persistent ectopic pregnancy, a prospectively designed clinical trial was performed. Patients (n = 37) previously operated on for ectopic pregnancy by laparoscopic salpingostomy and found to have persistent disease were enrolled into the study. Methotrexate was given intramuscularly at a dose of 1 mg/kg body weight, with the number of doses administered depending on the presenting level of serum beta-human chorionic gonadotropin (β-hCG). Group 1 (n = 27), levels of 10–1500 mIU/ml, received a single dose; group 2 (n = 5), levels of 1500–2500 mIU/ml, received two doses 3 days apart; group 3 (n = 5), levels > 2500 mIU/ml, received three doses 3 days apart. Patients were followed with weekly transvaginal ultrasound examinations, and serum β-hCG and progesterone measurements. Results noted resolution in all three treatment groups without the requirement of surgery or further treatment: group 1, 19.9 ± 1.7 days; group 2, 35.2 ± 4.5 days; group 3, 49.0 ± 1.0 days. All patients remained asymptomatic, and no adverse side effects from the drug were experienced. We conclude, although preliminary, that a sliding scale approach to prescribing methotrexate based on the initial serum titer of β-hCG to treat persistent ectopic pregnancy is easy to use, efficacious, and likely results in complete resolution of the condition. In most cases, even with presenting levels of β-hCG > 2500 mIU/ml, persistent disease will resolve within 50 days of initiating care.


Also Published In

Journal of Gynecologic Surgery

More About This Work

Academic Units
Obstetrics and Gynecology
Published Here
August 20, 2012