GuidelinesOther guideline
Methotrexate for Ectopic Pregnancy
This booklet is intended as a practical guide to patient care for registrars, medical officers, interns and medical students attached to the gynaecology units at the University of the Witwatersrand Academic Hospitals. Anyone can use it.
Requirements for treatment with methotrexate are:
- Well patient
- Unruptured ectopic
- Patient who is well motivated, understands the treatment, and can be followed up, and lives relatively close to the hospital
- No fetal heartbeat on ultrasound
- Diameter of ectopic pregnancy on ultrasound < or = 3.5 cm
- hCG < 10,000 mIU/ml(IU/L)
- Consultant involved
Protocol for methotrexate
In fact there are many protocols
- Explain the treatment, including failure rate(see below), to the patient, and get consent
- FBC, U&E, LFT and hCG level. FBC and U&E results must be known before starting methotrexate
- Methotrexate 50mg/m2 or 75mg IM or orally as a single dose
- Folic acid is optional: give 10 mg orally three times daily after 24 hours, for 3 days(it is not required on single dose Methotrexate)
- The patient must return immediately if she has any increase in pain or feels unwell – record this advice in the file
- Follow up in 4 days: ask about symptoms, do a physical examination and ultrasound scan, and take blood for hCG level. The level should have gone down by at least 15%
- If the hCG level is falling, repeat again 3 days later. If the hCG level is not falling, but the patient is stable and agreeable, the methotrexate dose may be repeated once(there are longer protocols but don’t take chances)
Notes on methotrexate
About 20% of patients on this protocol will fail (require surgery). Alopecia does not occur with this dose of methotrexate. Marrow suppression and mucositis are not usually significant.