Management of tubal pregnancy with methotrexate

Summary. Ten women with tubal ectopic pregnancy were treated by the injection of methotrexate into the gestational sac under direct laparoscopic vision followed by a course of intramuscular therapy including folinic acid rescue. One course of treatment induced resolution of the extrauterine pregnancy in eight women. Complete resolution (β‐hCG<10 miu/ml) was achieved within 6–47 days (mean 14·5 days). Serum β‐hCG levels started to decline 3–4 days from the beginning of therapy. Length of hospital stay was 5–11 days (mean 6·4 days). Treatment failed in two patients. One woman had a laparoscopic tubal clip sterilization concomitantly with methotrexate treatment. Tubal patency was demonstrated in all the other seven women (100%) tested subsequently. There is a need to establish criteria for patient selection before methotrexate becomes a routine treatment for tubal pregnancy.