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Monitoring   single dose methotrexate in medical mx ectopic
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Monitoring single dose methotrexate in medical mx ectopic

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  • 1. TABLE 2 Multiple-dose MTX treatment protocol (28, 29). Treatment day Laboratory evaluation Intervention Pretreatment hCG, CBC with differential, liver function Rule out spontaneous Ab tests, creatinine, blood type and Rhogam if Rh negative antibody screen 1 hCG MTX 1.0 mg/kg IM 2 LEU 0.1 mg/kg IM 3 hCG MTX 1.0 mg/kg IM if <15% decline day 1–day 3 If >15%, stop treatment and start surveillance 4 LEU 0.1 mg/kg IM 5 hCG MTX 1.0 mg/kg IM if <15% decline day 3–day 5 If >15%, stop treatment and start surveillance 6 LEU 0.1 mg/kg IM 7 hCG MTX 1.0 mg/kg IM if <15% decline day 5–day 7 If >15%, stop treatment and start surveillance 8 LEU 0.1 mg/kg IM Note: Surveillance every 7 days (until hCG <5 mIU/mL). Screening laboratory studies should be repeated 1 week after the last dose of MTX. LEU ¼ leucovorin; IM ¼ intramuscu- larly. ASRM Practice Commitee. Treatment of ectopic pregnancy. Fertil Steril 2008. In both single- and multiple-dose MTX treatment proto- When the criteria described earlier are fulfilled, treatmentcols, once hCG levels have met the criteria for initial decline, with MTX yields treatment success rates comparable to thosehCG levels are followed serially at weekly intervals to ensure achieved with conservative surgery (2, 30, 31). Numerousthat concentrations decline steadily and become undetect- open-label studies have been published demonstrating the ef-able. Complete resolution of an ectopic pregnancy usually ficacy of both MTX treatment regimens. One review con-takes between 2 and 3 weeks but can take as long as 6 to 8 cluded that MTX treatment was successful in 78%–96% ofweeks when pretreatment hCG levels are in higher ranges selected patients. Post-treatment hysterosalpingography(29, 30, 35). When declining hCG levels again rise, the diag- documented tubal patency in 78% of cases; 65% of patientsnosis of a persistent ectopic pregnancy is made. who attempted subsequent pregnancies succeeded, and the TABLE 3 Single-dose MTX treatment protocol (33). Treatment day Laboratory evaluation Intervention Pretreatment hCG, CBC with differential, Rule out spontaneous Ab liver function tests, Rhogam if Rh negative creatinine, blood type and antibody screen 1 hCG MTX 50 mg/m2 IM 4 hCG 7 hCG MTX 50 mg/m2 IM if b-hCG decreased <15% between day 4 and day 7 Note: Surveillance every 7 days (until hCG <5 mIU/mL). ASRM Practice Commitee. Treatment of ectopic pregnancy. Fertil Steril 2008.S208 ASRM Practice Commitee Treatment of ectopic pregnancy Vol. 90, Suppl 3, November 2008

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