Protocol for Medical treatment (Methotrexate) of Ectopic Pregnancy. Written by The Royal Oldham Hospital. Revised March 2001

At the Royal Oldham Hospital, medical treatment should be offered only to carefully selected patients with ectopic pregnancy.

Advantages:

Good success rates (More than 90%) in appropriately selected cases

Comparable to conservative surgery in terms of subsequent fertility

General anaesthetic avoided

Disadvantages:

Risk of toxicity: nausea, stomatitis, bone marrow suppression, pneumonitis, elevated liver enzymes

Repeated visits to ensure resolution of pregnancy

Selection criteria:

Clinically stable

Able and willing to attend for follow-up scans and blood tests

Early unruptured ectopic pregnancy

• Under 8 weeks gestation

• No free fluid on ultrasound scan

• Ectopic sac <3cm

• No fetal heart pulsation in ectopic sac

• hCG <l0,000 iu/1

Surgery contraindicated or likely to be difficult

• medically unfit

• cervical ectopic

• cornual ectopic

• pelvic adhesions

Failed surgical treatment

• Persistent ectopic after conservative tubal surgery

• False negative laparoscopy

Management:

Discuss with consultant

Counsel patient, obtain consent and give information on medical treatment of ectopic pregnancy

Blood tests:

• FBC,

• Group & save serum,

• U& E,

• LFT

• hCG

Admit for overnight observation.

• Prescribe a single dose of intramuscular Methotrexate 50 (fifty) mg

• (if weight is <50kg, prescribe 1mg/kg)

Discharge the following day with discharge letter and the following advice:

• Avoid sexual intercourse

• Avoid alcohol

• Avoid folic acid

• Ectopic may rupture. To come back in immediately if feeling dizzy or exacerbated abdominal pain

• Avoid conception for 3 months

Anti-D to non-sensitised Rhesus negative patient.

Follow-up in EPAU

(Early pregnancy assessment unit attached to Ward one)

Twice weekly hCG until falling, then weekly until <10iu/1

• If hCG not falling, request ultrasound scan

• If no significant fall in hCG after 7 days, then consider either repeat methotrexate or surgical treatment (discuss with patient)

• Note: hCG may fall slowly. Median time to resolution is 1 month

• Discuss contraception

Warn regarding the risk of future ectopic pregnancy

Home | Top of Page