Category: Federal Forum Posters
Purpose: An ectopic pregnancy (EP) is a condition in which the implantation occurs outside the uterine activity. Medical intervention with methotrexate is well established as an alternative to surgery. Current practice at Women’s Hospital is driven by internationally accepted protocol, to administer single dose intramuscular methotrexate (MTX). Data about the efficacy of different methotrexate regimens is limited in Qatar. The study was designed to evaluate the suitability and efficacy of single-dose MTX 50 mg/m2 BSA used in the treatment of EP. This study further assessed the b-hCG levels and correlate them with success rates.
Methods: The study took place at a 220 bedded obstetric teaching hospital in Qatar. The study was approved by the medical research center at Hamad Medical Corporation. Medical records of all women diagnosed with EP and treated with MTX were retrospectively reviewed for a period of nine months. Women's Hospital complies to single dose MTX protocol by Stovall et.al. that is “single dose” protocol at a dose of 50 mg/m2 of body surface area. The study excluded all those patients who were treated with MTX and lost follow up for the next visit.
EP was diagnosed by the obstetrician based on clinical findings and correlated with ultrasound. MTX was indicated for all patients hemodynamically stable, tubal mass of less than .5 cm, absence of fetal cardiac activity and β-human chorionic gonadotropin (βHcG) less than 5000 IU. The overall success rate was determined by normalization of βHcG after first or second dose, while the failure was defined if the patient encountered hemodynamic instability, progressing βHcG values, or severe abdominal pain after two doses of MTX.
Results: Seventy-three patients from more than 11 different nationalities were treated with intramuscular MTX at Women’s Hospital over a period of 9 months. Approximately 80% of these patients had multigravida and 25% used assisted techniques for conception. Majority of women treated were between 31 - 35 years. Twenty percentages of the patients had history of one or more previous EP. The mean pretreatment levels of (βHcG) was 2527.7 of which almost 7% had βHcG levels > IU 5000. Seventeen percentage of the patients treated had relative contraindication to the MTX treatment. Almost 60.5% of the patients had successfully achieved a βHcG< 15 IU between Day 5 and Day 7 and an additional 18% required second dose. Approximately 95% of the EP was treated below 10 weeks gestation. The overall success rate of therapeutic management with MTX was more than 75%. The study findings revealed that the prearrangement βHcG levels were significantly lower in those who responded to the single dose MTX (P= 0.023). Gravida status, previous history of EP, location of EP was not found to be associated with the success rate of the treatment. No major adverse effects were noted during the study period.
Conclusion: The use of MTX during EP is safe and effective. Our study suggested that intramuscular MTX can be a safe alternative to surgery for hemodynamically stable unruptured tubal pregnancy. Timely detection, low (βHcG) levels and proper follow up are predictors of success.
Binny Thomas– Clinical Pharmacy Specialist, Medication Safety Cordinator, Hamad Medical Corporation, Doha, Ad Dawhah, Qatar