Tubal patency after local methotrexate injection for tubal pregnancy

Abstract

Tubal patency was investigated by hysterosalpingography in 21 of 37 patients with unruptured tubal pregnancy treated by local methotrexate injection at laparoscopy. 18 of the 21 patients had bilateral tubal patency, and the only tube of a patient with a single fallopian tube was also patent. 6 subsequent intrauterine pregnancies have so far been recorded. Local methotrexate injection into the tubal pregnancy may provide an efficient and safe alternative to surgery in early unruptured ectopic pregnancy.

PIP: Of 86 patients with tubal pregnancy admitted from January 1988-April 1989, 37 were treated with local methotrexate during laparoscopy, and of 21 who were evaluated 3 months after by hysterosalpingography, 19 had patent tubes. Women whose tubal pregnancy was less than 3 cm in diameter, had no active bleeding, and intact tubal serosa with good pelvic visualization were treated with the cytotoxic drug, injected directly into the gestational sac, either 12.5 mg (27 women) or 25 mg (10). Hysterosalpingography was performed on all but 16, because of 4 failures of methotrexate, 3 women sterilized, 5 who were pregnant, and 1 refusal. Of the remaining 21, 90.5% had patent tubes, 18 bilateral, and 1 a patent single tube. 2 patients had distally occluded tubes, ampullar pregnancies of 1 and 2 cm, and gestations of 50 and 56 days respectively. 2 other patients showed evidence of unrelated intrauterine lesions. This high rate of tubal patency compares well to conservatively managed tubal pregnancies, where 25-30% patency has been reported, to systemic administration of methotrexate, with 53-75%, and conservative surgery with 46-60% patency. The pregnancy rate to date in this series is 1 of the 21 who had hysterosalpingography and 6 among the 16 who were not tested.