Methotrexate treatment of tubal ectopic pregnancy: experience of Hospital of Lithuanian University of Health Sciences Kaunas Clinics

Abstract

Objectives To identify tubal ectopic pregnancies treatment with methotrexate outcomes in Hospital of Lithuanian University of Health Sciences (LUHS) Kaunas Clinics Obstetrics Gynaecology department. Materials and Methods A retrospective analysis was conducted for LUHS Kauno Klinikos Obstetrics and Gyneacology department registry data. All 2018-2019 years tubal ectopic pregnancy cases (n=40), where methotrexate was administered, were analyzed. The following criteria were evaluated: female demographics, risk factors and symptoms of tubal ectopic pregnancy, ultrasound findings, human chorionic gonadotropin (hCG) levels, number of methotrexate doses, treatment efficacy, and whether methotrexate was administered according to recently recommended criteria. The data was analyzed using “SPSS 23.0 for Windows”, the Fischer and Chi-squared tests were used. The results were statistically significant then p<0,05. Results Most patients were pregnant for the first time and on average 6 weeks of gestation, complained of abdominal pain and vaginal bleeding, which ultrasound usually showed a heterogeneous structure of varying size in the field of uterine adnexa. The most common risk factors among women were pelvic or abdominal surgery in the past (22.5 %), tubal ectopic pregnancy in the past (10.0 %) and intrauterine device (7.5 %). In most cases (92.5 %) methotrexate was administered according to recommended criteria. The outcome of methotrexate treatment is unknown in 35.0 % cases. Treatment of tubal ectopic pregnancy with methotrexate was effective in 76.9 % cases. Three out of four women (75 %) received a single dose, rest required the second dose of methotrexate. Urgent surgery was performed in 23.1 % of women, but when methotrexate was prescribed according to the recommended criteria - 17.4 %. All operations were performed after the first drug dose. Conclusions At LUHS Kaunas Clinics treatment of tubal ectopic pregnancy with methotrexate was successful in 76.9 %...