Single- vs. Double-Dose Methotrexate Protocols Examined in Ectopic Pregnancy
(HealthDay News) — For ectopic pregnancy, outcomes are similar with a single- and double-dose methotrexate protocol, according to a study published in the November issue of the American Journal of Obstetrics & Gynecology.
Michelle C. Mergenthal, M.D., from the University of Pennsylvania in Philadelphia, and colleagues conducted a multicenter cohort study involving clinical data from women who received medical management for ectopic pregnancy. The authors assessed the rates of human chorionic gonadotropin change and successful pregnancy resolution.
Of the 162 ectopic pregnancies included in the final analysis, 70 percent were treated with single-dose methotrexate and 30 percent with the two-dose protocol. The researchers found that site, race, ethnicity, and reported pain level correlated with differential protocol allocation. Initial human chorionic gonadotropin levels were similar in either protocol, but from day zero to day seven the mean rate of decline of human chorionic gonadotropin was significantly more rapid with the single-dose versus the two-dose protocol (mean change −31.3 percent versus −10.4 percent; P = 0.037). There were no significant differences in success rate or time to resolution for the two protocols.
"In a racially and geographically diverse group of women, the single- and double-dose methotrexate protocols had comparable outcomes," the authors write. "The more rapid human chorionic gonadotropin initial decline in the single-dose group suggested these patients were probably at lower risk for ectopic rupture than those getting the two-dose protocol."