Retrospective review of the medical management of ectopic pregnancies with methotrexate at a South African tertiary hospital

South African Journal of Obstetrics and Gynaecology

C A Cluver¹  Liesl de Waard¹  C J B Muller²  J L Butt¹ 

[1] Department of Obstetrics and Gynaecology, Tygerberg Hospital and Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa;Department of Statistics and Actuarial Science, Stellenbosch University, Stellenbosch, South Africa

关键词: Methotrexate;    Ectopic pregnancy;    Medical management;   

DOI  :  

学科分类：农业科学（综合）

来源: South African Medical Association

【 摘 要 】

Background. An ectopic pregnancy can be a life-threatening condition. Early diagnosis with ultrasonography and quantitative beta-human chorionic gonadotrophin (β-hCG) measurement has improved early and accurate diagnosis and treatment. Medical management with methotrexate internationally has a success rate of up to 93%, but there is a paucity of data on this treatment option in developing countries. Objective.To determine the success of methotrexate treatment for ectopic pregnancies at a referral hospital in a developing country. This non-surgical, outpatient treatment seems a good option in hospitals with an ever-rising pressure on bed occupation and long waiting lists for emergency surgery. Methods.A 5-year retrospective audit was performed on 124 patients treated for ectopic pregnancies with methotrexate at Tygerberg Hospital, Cape Town, South Africa. Results.With success defined as a β-hCG level of <15 IU/L without requiring surgical intervention, the success rate was 44%. Fifteen per cent of medically managed patients required surgery. The remaining 41% were lost to follow-up. One patient had a major adverse outcome with a ruptured ectopic and required 2 units of blood, resuscitation and emergency laparotomy.Conclusion.Medical management of ectopic pregnancies is a safe and effective management option, as proven by international data, but at Tygerberg Hospital the safety of this treatment modality cannot be guaranteed because of poor follow-up. Improvement in patient selection with consideration of predictors of success and thorough counselling, as well as full informed consent, is recommended before using this treatment modality. A new follow-up system should be developed at Tygerberg Hospital to guarantee patient safety.

【 授权许可】

Unknown