H/O 1ST PREG. IS RT.TUBAL ECTOPIC - present G2 pregnancy is
Lt. Tubal Ectopic pregnancy.
Findings :1st image :
Before Methotrexate shows lt. Tubal mass is round & distended
gestational sac. (Urine test for pregnancy is positive)
2nd image : 3rd day after Methotrexate. Lt.Tubal mass with small
& irregular gestational sac .
( Urine test for pregnancy is negative.)
3rd image : At the end of 1st. week after Methotrexate.
Lt.Tubal mass with
resolution / absorption of gestational sac.
4th image : At the end of 2nd. week . Lt. Tubal mass is small.
5th image : At the end of 4th. week. Lt Tubal mass is completely
resolved. Lt .ovary
shows immature follicles.
Conclusion: Regression of
lt.Tubal ectopic pregnancy after methotrexate
Discussion: Main indications of Mathotrexate in Ectopic pregnancy
are unruptured tubal pregnancy of less than 6weeks or gestation sac is
less than 3.5cms without cardiac activity & with intact Serosa .
There should be
no Hemoperitonium. Pre-requisites for Methotrexte treatment are base
line B HCG levels. Transvaginal scan before Methotrexte treatment
to rule out Hemoperitonium.Liver & renal functional , hematological
Mode of administration is by systemic & local. In systetic may be
single( 50mgs/m 2 - Intramuscular )/multiple
doses( 1mg/kg/day on alternate days). Local administration may be by
Laproscopic or Transvaginal
route ( 10mg into sac.)
Follow up scan on 4th ,6th day there after weekly if response is good
without any complaints.
Prognostic factors factors are shrinkage in size of gestation sac.
& above 15% fall between 4 and 7 days
after injection.5-10% may fail medical treatment and rupture can occurs
late as 23 days ,usually occur when gestation
sac is above 6weeks with fetal cardiac activity.
Complete resolution with systemic treatment occurred in 14 +92 days.
With TVS injection resolution occurred
within 2weeks with lesser dose need & lesser side effects
Tubal potency was restored in 80% of patients treated.
Pregnancy rate following Methotrexate treatment is 61-87%. 8-12 %
shows recurrent Ectopic.
Reference : Telindes, Vovak,
Textbook of Gyn & Obj.
Submitted : Dr.M.Adinarayana
Rao M.D. & Dr. Prabhavathi M. D.(GYN.&OBG.)