ABSTRACT

To study the prognostic significance of tubal implantation site on success of methotrexate (MTX) treatment and reproductive outcome in ectopic pregnancies (EP).

Localization of ectopic pregnancies were determined and recorded by ultrasonography. Ninety-eight tubal EP cases meeting the conditions of haemodynamic stability and absence of fetal cardiac activity, were admistered MTX (50 mg/m2 intramuscularly). Main outcome measurements were as follows; positive result with methotrexate was regarded as decreasing -hCG titer in blood until it was zero. The necessity of any invasive intervention was considered as failed MTX therapy. Recurrent EP and intrauterine pregnancy rate was recorded in patients who desired to become pregnant within one year after treatment for EP.

Efficacy of MTX treatment was found to be 82.3%. It was successful in 91.6% of periampullar EP, but the success rate was 28.5% in periisthmic EP (p<0.01). Periisthmic EP was found to be a poor prognostic factor for the success of MTX treatment (OR: 27.5; 95% CI: 6.8-110.8; p<0.001). Fifty-nine patients desired pregnancy within one year after termination of EP. Although the overall cumulative pregnancy rates were similar, the rate of intrauterine pregnancy was significantly lower in periisthmic EP (25%) than in periampullar EP (87%) cases.

Ultrasonographically determined implantation site of tubal EP is a significant factor affecting success with MTX and the subsequent reproductive outcome.

Keywords: ectopic pregnancy, methotrexate treatment, reproductive outcome, predictive factors, tubal localization