[Methotrexate administration in the treatment of unruptured tubal pregnancy. Prospective non-randomized study: intramuscular injection versus transvaginal sonography-guided injection].

OBJECTIVES

The aim of this study was to compare in a prospective non-randomized study, the efficacy of two methods of administering methotrexate (MTX) in the treatment of ectopic pregnancy (EP): transvaginal injection under sonographic control or intramuscular injection (IM).

METHODS

Patients with EP who met specific inclusion criteria for medical treatment were treated by MTX: 73 patients (group 1) were treated by IM and 47 patients (group 2) by transvaginal local injection.

MATERIALS AND METHODS

In group 1,50 mg/m(2) of MTX was injected intramuscularly; in group 2,1 mg/kg of MTX was injected transvaginally into the ectopic sac under sonographic guidance. Choice of the route depended on the physician's experience.

RESULTS

The overall success rate, defined by a normal post-treatment hCG level (<10 mUI/mL) was 71.4% in group 1 versus 91.5% in group 2 (p<0.01); for patients with hCG levels<2,000 mUI/mL, 83% and 96% respectively (not significant); for patients with hCG 2,000 mUI/mL, 37.5% and 86.4% respectively (p<0.01).

CONCLUSION

For medical treatment of EP, the efficacy of MTX is greater when administered by local transvaginal injection than by IM injection. We propose local treatment whenever the EP can be punctured, especially when hCG levels are 2,000 mUI/mL.