Evaluation of the Two-Dose Methotrexate for medical treatment of Ectopic Pregnancy: A Retrospective case series study.

Abstract

Background:Tubal ectopic pregnancy is a significant cause of maternal morbidity in first trimester of pregnancy, owing to wide resorting to ovulation induction and assisted reproduction it is said to be  rising in incidence and with improved imaging modalities and their early accessibility early diagnosis of ectopic pregnancies dominates the current management practice and this makes  methotrexate therapy offers a desired non-surgical treatment option. Variable methotrexate regimes has been tried to achieve medical cure of ectopic pregnancy, the two-dose methotrexate regimen is considered effective and well-tolerated for stable patients, and the current study is designed to test it is effectiveness and find predictors of medical treatment success with two dose methotrexate regieme.

Aim of the study: To demonstrate the medical treatment outcomes for tubal ectopic pregnancy at Al-Zahraa teaching hospital and to analyse the factors influencing treatment success, including patient demographics, clinical presentation, and initial β-hCG levels and to determine the rate of surgical intervention following medical treatment.

 Patients and methods: Retrospective case series study included 25 patients with tubal ectopic pregnancy treated with a two-dose methotrexate protocol. Patient demographics, clinical characteristics, serum β-hCG levels, ectopic mass size, treatment outcomes, and complications were gathered and studied.

Results: Medical management was successful in 76% of cases. Patients with lower initial β-hCG levels (2,500–4,500 mIU/mL) and smaller ectopic masses (2–4 cm) had significantly higher success rates (p=0.021 and p=0.037, respectively). Treatment failure occurred in 24% of patients who required surgical intervention, mainly due to persistent β-hCG or tubal rupture. Adverse events were minimal, reported in 8% of patients, and generally mild.

Conclusions: The two-dose methotrexate regimen is an effective and safe treatment for selected patients with tubal ectopic pregnancy. Initial β-hCG levels and ectopic mass size are significant predictors of treatment success. Careful monitoring and strict follow-up are essential to identify non-responders early..