Single injection of methotrexate for treatment of ectopic pregnancies.

Objective: Our purpose was to evaluate the efficacy of single-dose methotrexate as a treatment option for ectopic pregnancies.

Study Design: Patients were recruited from a tertiary teaching hospital setting. They had (1) a gestational sac < 3.5 cm, (2) no fetal cardiac activity, and (3) no significant pelvic pain or signs consistent with hemoperitoneum. Patients excluded were those who did not desire future fertility or who had evidence of renal or liver disease. Sixty-one patients meeting these criteria were selected and treated with a single intramuscular injection of methotrexate at a dosage of 50 mg/m2.

Results: Of the 61 patients treated, 16 required a second injection and nine required surgical intervention. Fifty-two (85%) were successfully treated as outpatients with methotrexate alone.

Conclusion: Nonsurgical treatment of ectopic pregnancies with single-dose methotrexate is an option for some patients, but more studies are needed to establish the safety, efficacy, and effect on fertility.