RT9-ED article and summary

Management of uterine ectopic pregnancy – local vs. systemic methotrexate.

Summary of articles

  • This is a prospective randomized control trial
  • Purpose of this study: To compare ultrasound-guided local methotrexate (MTX) vs. systemic methotrexate in ectopic pregnancy regarding the beta human chorionic gonadotropin (hCG) clearance duration
  • Method: 46 patients with ectopic pregnancy
  • Systemic MTX group: 15 patients. 50mg/m2 body weight is given intramuscularly
  • Local MTX with ultrasound guided group: 24 patients. 25mg MTX as fixed dose is given locally
  • Outcomes

Both groups are followed up until beta HCG clearance

Primary outcomes: beta HCG clearance duration

Secondary outcomes: adverse events, such as bleeding, pain, or need of surgery intervention

  • Results:

The mean beta HCG clearance duration of systemic MTX group is 31.5 days, and local MTX group is 64.7 days

There is no significant difference between two groups regarding bleeding, pain or need of surgery intervention

  • Conclusion

In conclusion, there is a significantly 29.2 days longer duration of beta HCG clearance in patients with ectopic pregnancy who received ultrasound-guided local MTX compared to systemic MTX

  • Relating to my patient

My patient, Ms. C is 30 years old female, with ectopic pregnancy. Since the patient is stable, and the ultrasound shows no viable intrauterine gestation, so medical treatment is indicated. She is hemodynamically stable, and methotrexate 89mg IM is recommended from the GYN team. Systemic MTX has a shorter duration of beta HCG clearance. However, there are some limitations for this study. The sample size is small. Further study and research based on a larger sample size will be needed to explore the efficacy of local MTX.

ectopic pregnancy

 

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