MEDICAL MANAGEMENT WITH ORAL METHOTREXATE FOR ECTOPIC PREGNANCY WITH HIGH THCG IN SHAH ALAM HOSPITAL. 

INTRODUCTION

Ectopic pregnancy is defined as implantation outside uterine cavity. It can be detected early base on ultrasonographic finding together with serum HCG level. It can be treated successfully either with medical management methotrexate or with minimally invasive surgery. The American College of Obstetricians and Gynaecologists has recommended medical treatment for patients who are hemodynamically stable with no evidence of rupture. There are numerous reports describing successful treatment of ectopic pregnancies using methotrexate (MTX) regimens. In systematic review reported there is statistically significant increase in failure rate of medical treatment who have initial HCG levels of >5,000 mIU/mL comparing with those who have initial levels of 5,000 mIU/mL

 

OBJECTIVES

1) To determine the success rate of oral methotrexate in Hospital Shah Alam in patients with high initial total HCG level of more than 5000 mIU/mL

2) To make medical treatment an available option for patient with HCG> 5000mIU/ml

 

METHODS

This is a retrospective study of 16 patients in Hospital Shah Alam who received oral methotrexate as their treatment for ectopic pregnancy. Selection criteria included hemodynamically stable women with total HCG level of ≥5000 mIU/ml, adnexal mass ≤3.5 cm, absent cardiac activity and minimal hemoperitoneum. They were prescribed with oral methotrexate with the dose of 60 mg / BSA given in 3 divided doses every 2 hours using the standard tablet of 2.5mg on day 1 and again on day 4. Data collected and analyses using SPSS system

 

RESULT

9 patients were successfully treated with oral methotrexate (56%) while the other 7 patients had to undergo surgery with confirmed leaking or ruptured tubal pregnancy. 2 of the successful patients does not need second methotrexate dose. In failed treatment group 3 of the patients diagnosed with cornual pregnancy. Factor associated with successful treatment includes, site , parity and age. From the data , noted more cases with tubal pregnancy and patient with multiparity were successfully treated with MTX compared to other site of ectopic and primigravida patient. The side effects of oral methotrexate were tolerated well by all patients. The average time of biochemical resolution of ectopic pregnancy was between 23 to 60 days. The longest time for biochemical resolution was for a patient with total hCG >20 000 IU. No major side effects were reported.

CONCLUSION

Oral methotrexate in 2 doses/cycle (day 1 and day 4) can be an option for patient with higher level of total hCG provided patient is stable and is well informed that the success rates is lower (56%). Methotrexate should be used with caution in patients with ectopic pregnancy who present with higher hCG level.

 

 

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