Single high dose of local methotrexate for the management of relatively advanced ectopic pregnancies.

Objective: To evaluate the limits of the conservative management of relatively advanced ectopic pregnancies (EPs) with local methotrexate given at a higher than standard dose.

Design: Nonrandomized prospective study.

Setting: A tertiary teaching hospital and an affiliated infertility center.

Transvaginal intra-amniotic injection of methotrexate in early ectopic pregnancy. Advantages over the laparoscopic approach.

Methotrexate (MTX, 100 mg) was administered to 36 patients with early ectopic pregnancy locally, either under laparoscopic control into the distended fallopian tube (group A, n = 16), or transvaginally into the gestational sac directly, under ultrasound guidance (group B, n = 20). In cases with persistent beta-hCG levels (n = 7), an additional 50 mg of MTX solution was instilled into the affected tube, following transuterine tubal catheterization. Comparing the two different routes of MTX administration, it was shown that the resolution time (beta-hCG < 20 mIU/ml) in group B was significantly shorter (2.