Methotrexate for the treatment of unruptured tubal ectopic pregnancy

Objective: The objective of this study was to determine the outcomes of women who presented to the emergency department (ED) with suspected ectopic pregnancy and received methotrexate as first-line treatment. Methods: This was a retrospective chart review of pregnant (< 12 week' gestational age) women from an academic tertiary care ED with a diagnosis of ectopic pregnancy, rule-out ectopic pregnancy, or pregnancy of unknown location over a 7-year period. Results: Of 612 patients with a suspected ectopic pregnancy at initial ED presentation, 326 (53.3%) had non-ectopic pregnancy outcomes, 30 (4.9%) were diagnosed with a ruptured ectopic pregnancy at the index ED visit, and 18 (2.9%) were diagnosed and managed as non-tubal ectopic pregnancies and excluded from further analyses; 238 patients were diagnosed with a tubal ectopic pregnancy, and 152 (63.9%) were treated with methotrexate at the index ED visit or in follow-up. Of patients treated with methotrexate, 27 (17.8%) went on to require surgical management, with 17 (11.2%) documented as having ruptured on surgical evaluation. Conclusion: The proportion of patients failing methotrexate as first-line treatment was higher than previously reported. Further investigation is needed to determine whether methotrexate failure was due to non-adherence to recommended guidelines.