Ectopic pregnancy: Methotrexate therapy
- Togas Tulandi, MD, MHCM
Togas Tulandi, MD, MHCM
- Professor of Obstetrics and Gynecology
- Milton Leong Chair in Reproductive Medicine
- McGill University, Canada
An ectopic pregnancy is a pregnancy outside of the uterine cavity. Almost all ectopic pregnancies occur in the fallopian tube (98 percent) , but other possible sites include cervical, interstitial (also referred to as cornual; a pregnancy located in the proximal segment of the fallopian tube that is embedded within the muscular wall of the uterus), hysterotomy scar (eg, in a women with a previous cesarean delivery), intramural, ovarian, or abdominal. In addition, in rare cases, a multiple gestation may be heterotopic (include both a uterine and extrauterine pregnancy).
Ectopic pregnancy is a potentially life-threatening condition. While surgical approaches are the mainstay of treatment, many women are candidates for medical therapy with methotrexate because of advances in early diagnosis . The overall success rate of medical treatment in properly selected women is nearly 90 percent [3,4].
Treatment of ectopic pregnancy with methotrexate (MTX) will be reviewed here. The surgical treatment of ectopic pregnancy is reviewed elsewhere (see "Ectopic pregnancy: Surgical treatment"). Related topics regarding ectopic pregnancy are discussed in detail separately, including:
●Epidemiology, risk factors, and pathology (see "Ectopic pregnancy: Incidence, risk factors, and pathology")
●Clinical manifestations and diagnosis (see "Ectopic pregnancy: Clinical manifestations and diagnosis")
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- CLINICAL PHARMACOLOGY
- Route of administration
- Adverse reactions
- CLINICAL PROTOCOL
- Pretreatment testing
- Efficacy of single versus multi-dose therapy
- - Single-dose protocol
- - Multiple-dose protocol
- Precautions during therapy
- Pain after treatment
- SUBSEQUENT PREGNANCY
- Interval to conception
- Obstetric outcome
- INTERSTITIAL PREGNANCY
- NONTUBAL ECTOPIC PREGNANCY
- COMBINED USE WITH OTHER MEDICATIONS
- Other agents
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS