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Table 5 Studies on medical management of IPs

From: The diagnosis and management of interstitial ectopic pregnancies: a review

Paper Location MTX route of administration No. of cases Patient age (years) Gestation (weeks) Diameter of GS (mm) Foetal cardiac activity (FCA) present β-hCG (mIU/mL) Comments
Hafner et al. 1999 [30] King’s College Hospital (London, UK)
Prospective interventional study
2 cases of systemic MTX (2 doses 1 mg/kg IM, 48 h apart, with rescue folinic acid)
5 cases of local MTX (single 25 mg dose of MTX, TVUS-guided, injected into the GS)
3 cases: 2–4 mEq of KCL + MTX if FHR present
10 34.18 6.5 (6–9) 24.8 (9–51) 3 9574 (102–41,150) 90% success rate in total
100% success rate with local MTX therapy
80% for systemic MTX
No rupture
No difference between local and systemic MTX Rx in time taken for resolution of β-hCG
Mean 18.8 days for β-hCG to resolve (max 32 days)
All 3 FCA treated successfully
Jermy et al. 2004 [6] St George’s University Hospital (London, UK)
[1998–2002]
Prospective observational study
Single dose MTX IM 18 32.7 5.4 30.39 (12–54) 4 6452 (32–31,381) 50% treated successfully with 1 dose of MTX
80% treated successfully with second dose of MTX
All 4 FCA cases treated successfully
No ruptures
All patients with β-hCG < 5000 IU were treated successfully with single dose MTX
Hospital stay (days) 7 (0–40)
No side effects secondary to MTX
Tulandi et al. 2004 [7] Multi-centre
(Europe, North America, Chile)
[1999–2002]
Retrospective case series
4 cases: local MTX
4 cases: systemic MTX
8 32.6 7.9 +/− 0.9 15 +/− 9 4683 +/− 2056 62.5% success rate
37.5% required second intervention (surgical treatment)
No ruptures
FCA not a factor in treatment success
Mean interval between MTX administration and β-hCG resolution was 52.7 +/− 36.0 days
Cassik et al. 2005 [14] King’s College Hospital (London, UK)
[1996–2003]
Retrospective case series
23 cases: local MTX injection
5 cases: systemic MTX
28 7 (4–13) 5 Local MTX: 6006 (102–69,820)
Systemic MTX: 5576 (793–41,150)
85.7% success rate overall
Local MTX: 91% success rate
Systemic MTX: 80% success rate
No significant differences in success rates between the three different management options (P > 0.05)
None of the women receiving local MTX experienced significant side-effects
1 failed case had a ruptured ectopic
Tang et al. 2006 [46] Royal Brisbane and Women’s Hospital (Australia)
[2000–2005]
Retrospective case series
Medium-dose IV MTX (100 mg/5 min, followed by 200 mg/12 h), with oral folinic acid rescue (15 mg) on day 0 11 31 6.45 (5–8) 20.72 (10–60) 4 25,473 (1600–106,634) 91% success rate
1 case required second dose of MTX on day 17 (due to plateauing β-hCG), followed by
emergency laparotomy on day 31 for rupture
Surbone et al. 2013 [47] University Hospital of Lausanne (Switzerland)
[2001–2011]
Retrospective case series
3 cases: single dose IM MTX
6 cases: local MTX, injected into the cornual region
9 33 (25–39) 6 (5–9) 5838 (2974–15,022) 88.9% success rate
1 case who received IM MTX required a second dose of IM MTX, followed by laparoscopic cornual resection
Hiesch et al 2014 [11] The Helen Schneider Hospital for Women (Israel)
[2003–2013]
Retrospective case series
14 case: multi dose MTX regimen
3 cases: single dose MTX
17 32 +/− 5.8 6.5 +/− 1.3 36.0 +/− 24.1 3 15,763 +/− 25,147 70.5% success rate
All 3 patients treated with single-dose MTX were successful
5 unsuccessful cases of multi-dose MTX required selective uterine artery MTX injection
Poon et al. 2014 [18] King’s College Hospital (London, UK)
[? years]
Retrospective case series
16 cases: local MTX
3 cases: systemic MTX
19 7.8 (6–12.6) 13.0 (10–48) 4 7131 (562–8464) No comments
Framarino et al. 2014 [48] Umberto I Hospital, Sapienza University (Rome, Italy)
[2007–2012]
Retrospective observational study
Local MTX (TVUS-guided) 14 31 +/− 3 6.5 +/−  1.0 2 2146 +/−  807 100% success rate, so no second line Rx needed, and no patients required hospitalisation
No reported side-effects from MTX
β-hCG levels had normalised within 2 months, but (on US) the GS disappeared more slowly (taking about 4 months)
Tanaka et al. 2015 [49] Royal Brisbane and Women’s Hospital (Australia)
[2000–2012]
Retrospective observational study
Double dose of IV MTX 33 31.8 (21–43) 6.45 24.1 7 20,546 (230–106,634) 93.9% success rate
2 cases (6.1%) complicated by rupture
β-hCG resolution took an average of 55.6 (19 to 137) days
3 patients had side-effects from MTX