Evaluation of Risk Factors and Efficacy of Methotrexate Therapy in Unruptured Ectopic Pregnancy: A Prospective Analysis from a Tertiary Care Centre in Tamil Nadu

Abstract

Introduction: Ectopic pregnancy is a significant cause of maternal morbidity and
mortality, accounting for approximately 1-2% of all pregnancies. It occurs when a
fertilized egg implants outside the uterine cavity, most commonly in the fallopian
tube. Methotrexate, a folic acid antagonist, has been widely used for the medical
management of unruptured ectopic pregnancy, offering a non-surgical alternative that
preserves fertility. This study aims to evaluate the efficacy and safety of methotrexate
therapy in unruptured ectopic pregnancy and analyze the associated risk factors.
Materials and Methods: This prospective observational study was conducted at the
Kanyakumari district, Tamil Nadu, from January 2023 to December 2023. A total of
34 women diagnosed with unruptured ectopic pregnancy were included based on
specific inclusion criteria. The study participants were treated with either a singledose or two-dose methotrexate regimen. Data were collected on demographic
characteristics, medical history, and pretreatment β hCG levels. The primary outcome
was the success rate of methotrexate therapy, while secondary outcomes included the
need for surgical intervention and the incidence of side effects.
Results: The study found an overall success rate of 85.3% for methotrexate therapy,
with the single-dose regimen being successful in 61.8% of cases and the two-dose
regimen in 23.5%. Surgical intervention was required in 14.7% of the participants,
all of whom initially received a single dose. A significant correlation was observed
between pretreatment β hCG levels and treatment success, with higher success rates
in women with lower β hCG levels. Mild side effects were reported in a small
percentage of participants, with no major adverse events.
Conclusion: Methotrexate therapy is an effective and safe option for the medical
management of unruptured ectopic pregnancy, particularly in women with low
pretreatment β hCG levels. Early detection and appropriate patient selection are
crucial for optimizing outcomes and minimizing the need for surgical intervention.