Treatment success with two doses of methotrexate vs single dose of methotrexate in Ectopic Tubal Pregnancy

Objectives: To compare the success rates and safety of two-doses of methotrexate versus single dose of methotrexate in ectopic tubal pregnancy.

Methods: This was an open-label, randomized controlled trial done at “The Department of Obstetrics & Gynecology, Nishtar University Hospital, Multan” from January 2020 to July 2021. A total of 100 women (50 in each group), aged 20 to 35 years with a tubal ectopic pregnancy were enrolled. All patients were randomly allocated to either single-dose or two-dose methotrexate protocol. Cases were evaluated for treatment success, side effects, beta-human chorionic gonadotrophin (β-hCG) resolution time and treatment satisfaction.

Results: In a total of 100 cases, mean age was 29.6±4.5 years. Mean serum β -hCG levels at baseline was 1212±78 mIU/ml. Treatment success was noted among 43 (86.0%) cases of single-dose group versus 45 (90.0%) cases (p=0.5382). Duration of β -hCG resolution time was significantly shorter in two-dose group (23.0±12.1 days versus 28.2±12.8 days, p=0.0394). No significant difference was noted in methotrexate associated side effects in both study groups (p=0.9996). Overall, mean satisfaction score was 4.0±1.3 (out of 5).

Conclusion: Although, β -hCG resolution time was significantly low in two-dose protocol but single-dose methotrexate offered comparable success rates versus two-dose protocol. Side effects were mild and comparable in both methotrexate treatment protocols. Methotrexate was found to be effective in the medical management of ectopic pregnancy.