[Limits of ambulatory medical treatment of ectopic pregnancies by intramuscular methotrexate: prospective study on 54 patients].

Objective: To evaluate the limits of ambulatory treatment of ectopic pregnancy with an intramuscular injection of 50 mg/m2 methotrexate.

Method: Non randomised prospective study from october 1993 and april 1996 at Poissy Hospital. 100 ectopic pregnancies were diagnosed: 54 were treated medically and 46 had a surgical treatment.

Results: The mean hCG for the ectopic pregnancies treated medically was 7,273 Ul/ml +/- 12,548 (90-68,220), an ectopic mass was seen in 74% and to precise the diagnosis a currettage was done in 24 cases (44%) if the initial hCG was below 2,000 Ul/ml. The medical treatment was a success for 37 (68.5%) ectopic pregnancies with a mean time of resolution of hCG of 31.9 days +/- 18 (4-90) (with a positive correlation between initial hCG titer and time to resolution of 0.5, p = 0.001). For 15 (27%) patients a second dose of methotrexate was necessary with a 73% success rate and 17 (32%) patients were operated (8 salpingectomies). Sixteen of 20 (80%) demonstrated tubal patency at follow-up hysterosalpingogram and within 7.5 +/- 4 months 26 of 30 (87%) conceived and there was no recurrence of ectopic pregnancy.

Conclusions: The medical treatment of ectopic pregnancies with methotrexate has its limits. In our series, if we treat ectopic pregnancies without cardiac activity, with a mass below 35 mm and a hCG below 10,000 Ul/ml the success rate is 81%.