Abstract

Introduction: Methotrexate (MTX) was traditionally administered using the multi-dose regimen or single-dose protocols to treat ectopic pregnancies. The two-dose regimen was described as a cross between these two previous protocols aiming to lower side effects than multi-dose with a higher success rate of single-dose protocols. Hence, this study compared double-dose versus singledose methotrexate therapy in the treatment of ectopic pregnancy.

Methods: This prospective cohort study was performed on the women referred to the academic hospitals of Mashhad University of Medical Sciences from March 2018 to July 2021 who were diagnosed as having stable tubal ectopic pregnancy and selected for medical treatment with methotrexate. Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS) software (version 26). P≤0.05 was considered a significant level.

Results: A total number of 347 patients were included in this study. About 300 cases were evaluated: 240 cases in single-dose and 60 cases in the double-dose group. The Beta Human chorionic gonadotropin (Beta-hCG) declined more than 15% between days 4 and 7 and was significantly higher in the double-dose group (P<0.001). Regarding the time from MTX administration until Beta- hCG level <5 mIU/mg, this time was significantly shorter in the double-dose group (P=0.045). Considering the side effects, there was no complication in any of the groups. However, tubal rupture was seen in 17 cases of double-dose and 10 cases in the single-dose group, respectively.

Conclusion: The results of the current study showed a higher treatment success rate in double-dose MTX protocol with comparable side effects compared to single-dose MTX protocol for the treatment of stable tubal ectopic pregnancy.

Keywords: Ectopic pregnancy, tubal pregnancy, methotrexate, treatment, medical management, β subunit.

Graphical Abstract