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Self-Assessment Questions

Obstetrics & Gynecology

Answer 3
  1. Intramuscular MTX. The treatment of ectopic pregnancy has evolved toward a predominantly nonsurgical approach. Laparotomy with unilateral salpingo-oophorectomy, favored for many years, gave way to salpingectomy with ovarian preservation and salpingostomy. The laparoscopic approach to these procedures was demonstrated to be safe and effective. Medical therapy (MTX) for ectopic pregnancy began in the 1980s and has supplanted surgery for most stable patients. MTX is a folic acid antagonist that deactivates dihydrofolate reductase, thereby depleting a cofactor necessary for DNA and RNA synthesis, and thus preventing trophoblast cells of an early pregnancy from rapidly dividing. Most MTX regimens utilize single- or multiple-dose treatment with intramuscular injections. Contraindications or factors that increase the failure rate of MTX therapy include hemodynamic instability, presence of fetal cardiac activity, and elevated hCG levels. There is no consensus on what hCG level is considered an absolute contraindication to MTX therapy.3,4

    3. Barnhart KT, Gosman G, Ashby R, Sammel M. The medical management of ectopic pregnancy: A meta-analysis comparing “single dose” and “multidose” regimens. Obstet Gynecol 2003;101:778-84.

    4. Lipscomb GH, Bran D, McCord ML, et al. Analysis of three hundred fifteen ectopic pregnancies treated with single-dose methotrexate. Am J Obstet Gynecol 1998; 178:1354-8.

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