Ectopic Pregnancy: Is Methotrexate Safe For Ectopic Pregnancy?

I had an ectopic pregnancy and was treated with methotrexate. I believe this was done to save my HMO money. I had complications, so I looked into this treatment and read that it is unapproved for this use and can have severe side effects. Is methotrexate safe? Would surgery have been a safer alternative?

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Peg Plumbo CNM

Peg Plumbo has been a certified nurse-midwife (CNM) since 1976. She has assisted at over 1,000 births and currently teaches in the... Read more

I can understand your doubts that your HMO had your best interests at heart when your care providers opted for an obviously lower cost treatment for your ectopic pregnancy. However, such treatment is quickly becoming the standard of care for this condition.

As with all fairly new modalities of therapy, however, some care providers are unsure of who are the best candidates for such treatment.

In a recent issue of the New England Journal of Medicine (December 26, 1999), this issue was addressed. The conclusions of the research showed that single-dose, intramuscular methotrexate can be a viable alternative to surgery. They also concluded that the best candidates for the medical treatment are women who are "stable" (not in shock) and had no evidence of rupture of the tube or area of implantation. They should also have no evidence of chronic organ disease.

Methotrexate is administered at a dose of 50 mg. per square meter of body surface area, with additional doses up to a maximum of three, given if the serum hCG level does not decline by at least 15 percent between day four and seven, or if fetal cardiac activity is still present. Treatment can be considered successful when the hCG level declines to 15 mIU per ml or less without the need for surgical intervention.

When fetal heart activity is present, treatment failure occurs more Often, as it does when the serum hCG level is high.

When surgery can be safely avoided, the chance that fertility is preserved is higher and the risks are substantially lower of further disability. Infection rates are lower as well when methotrexate is used appropriately.

I would encourage you to speak to your patient service representative about your feelings about your care. Without knowing more about your situation, it is hard to counsel you about the appropriateness of the therapy. Even if used correctly, however, complications can arise.

The loss of your baby is often unrecognized in situations such as ectopic pregnancy. Care providers may feel that they saved your life and forget that a baby and a life was lost. It is important for you to feel that your grief and feelings have been recognized. If you feel comfortable enough, I would try to discuss this with an understanding nurse in the clinic or with the physician in charge of your care.

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