Methotrexate(MTX), a cytotoxic drug that is largely used in cases of gestational trophoblastic diseases, had previously shown promise in resolving unruptured ectopic pregnancy when given systemically, there by eliminating the need for surgery.
However,
its systemic use exposes the patients to serious side effects and toxicity. To minimize the risk of side effects and maximise benifits from high tissue concentration of MTX in the fallopian tube, the drug was locally applied by one injection to
the
pregnancy site. We performed local MTX injection to ectopic pregnancies by laparoscopy (8 cases) or transvaginal route(3 cases) and obtained following results.
The mean hCG level on admission was 8,867 mIu/ml (range; 179~32,057)and the mean days of resolution of hCG below 5 mIu/ml were 34 days. The mean days of hospitalization were 4 days. No serious or treatable toxicity by MTX injection was occured
during
procedure and follow-up. There were 3 ectopic patients(27%) who were ruptured during follow-up and required salpingectomy. The ectopic case who had positive fetal heart beat or initial high hCG was high failure rate & probably was required
repeated
injection or systemic adjuvant injection. The transvaginal injection under transvaginal sonography guided was more convenient than laparoscopic injection on the definite ectopic sac.
Our experience suggests that local injection of MTX may be an effective alternative for the treatment of unruptured ectopic pregnancy. And, there is a need to establish criteria for patients selection before local MTX injection becomes a routine
treatment for unruptured tubal pregnancy.
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