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  • Title: Local methotrexate injection: a nonsurgical treatment of ectopic pregnancy.
    Author: Pansky M, Bukovsky I, Golan A, Langer R, Schneider D, Arieli S, Caspi E.
    Journal: Am J Obstet Gynecol; 1989 Aug; 161(2):393-6. PubMed ID: 2475018.
    Abstract:
    Twenty seven patients with unruptured tubal pregnancy were selected for nonsurgical treatment with the use of one injection of 12.5 mg of methotrexate into the ectopic site at laparoscopy. No adverse reactions were observed. In three patients (11%), a laparotomy was performed because of rising beta-human chorionic gonadotropin titers. In the other patients, serum beta-human chorionic gonadotropin levels decreased to the nonpregnant range with no further intervention, and the patients recovered uneventfully. This method is suggested as an alternative to surgery in selected cases of early unruptured tubal pregnancy. A nonsurgical approach to the treatment of unruptured ectopic pregnancy--injection of 12.5 mg of methotrexate into the ectopic site at laparoscopy--was evaluated in 27 patients. Local administration does not carry the serious side effects and toxicity associated with systemic application of this agent. The location of the tubal pregnancy was ampullary in all 27 patients; the mean gestational age was 46 days and serum beta human chorionic gonadotropin (hCG) levels ranged from 55-1860 mIU/ml at admission. Use of local injection of methotrexate under laparoscopic control enabled abdominal surgery to be avoided in 24 (89%) patients. It took an average of 12 days for hCG levels to drop to 10 mIU/ml in these 24 patients; hospitalization averaged 4 days (range, 2-11 days). None of the treated patients had any adverse reactions related to the methotrexate. In the 3 remaining cases, laparotomy was necessary because of rising beta-hCG levels. 2 of these 3 patients had the highest preoperative beta-hCG titers, suggesting that a higher dose of methotrexate may have been indicated. Since local injection of methotrexate shortens the hospital stay and avoids surgical complications, more widespread use of this mode of treatment is urged in patients with early unruptured tubal pregnancy.
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