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 |