Systemic methotrexate (MTX) in early pregnancy: a retrospective study of a tertiary maternity hospital.

Autor: Lutfi A; Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, Cork, Ireland. ahmed.lutfi@hse.ie., Hayes-Ryan D; Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, Cork, Ireland.; Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland.; Department of Obstetrics and Gynaecology, National Perinatal Epidemiology Centre, University College Cork, Cork, Ireland., Cottrell E; Department of Pharmacy, Cork University Hospital, Cork, Ireland., Greene RA; Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, Cork, Ireland.; Department of Obstetrics and Gynaecology, National Perinatal Epidemiology Centre, University College Cork, Cork, Ireland.
Jazyk: angličtina
Zdroj: Irish journal of medical science [Ir J Med Sci] 2024 Oct; Vol. 193 (5), pp. 2389-2395. Date of Electronic Publication: 2024 Jul 09.
DOI: 10.1007/s11845-024-03748-9
Abstrakt: Background: Methotrexate (MTX) is used in clinical practice as a medical treatment option in patients with early pregnancy complications like ectopic pregnancy.
Aims: To review systemic MTX therapy use in the first trimester of pregnancy in our hospital and to examine subsequent clinical outcomes.
Methods: Retrospective review of all women treated with systemic MTX in early pregnancy identified from electronic prescription records from 1 January 2018 to 31 December 2020 at Cork University Maternity Hospital, Ireland. Relevant data was transcribed from electronic health records.
Results: Indications for treatment were tubal ectopic pregnancy (70%, n = 51), persistent pregnancy of unknown location (22%, n = 16) and caesarean scar pregnancy (7%, n = 5). Treatment was successful in 88% (n = 44) of tubal ectopic pregnancies with 73% (n = 37) and 14% (n = 7) of women receiving a single dose and repeated doses, respectively. Only 8% (n = 4) of tubal ectopic pregnancies required emergency surgery for subsequent tubal rupture. In 93% (n = 15) of cases of persistent pregnancy of unknown location, treatment was successful with one patient requiring uterine evacuation. Women with caesarean scar pregnancy were treated with combined MTX and uterine evacuation without complication.
Conclusions: The efficacy of medical treatment with systemic MTX for confirmed tubal ectopic pregnancy in our hospital is in line with national and international standards. Careful consideration should be given to treating caesarean scar pregnancy and persistent pregnancy of unknown location with systemic MTX. Systemic MTX use guided by clinicians specialised in early pregnancy complications and safe medication practices may improve treatment success and reduce adverse events.
(© 2024. The Author(s).)
Databáze: MEDLINE
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