HealthDay News — According to a study published in the American Journal of Obstetrics & Gynecology, outcomes are similar with a single- and double-dose methotrexate protocol for ectopic pregnancy.

Michelle Mergenthal, MD, from the University of Pennsylvania in Philadelphia, and colleagues conducted a multi-center cohort study involving clinical data from women who received medical management for ectopic pregnancy. The authors assessed the rates of human chorionic gonadotropin change and successful pregnancy resolution.

Of the 162 ectopic pregnancies included in the final analysis, 70% were treated with single-dose methotrexate and 30% with the 2-dose protocol. The researchers found that site, race, ethnicity and reported pain level correlated with differential protocol allocation. 

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Initial human chorionic gonadotropin levels were similar in either protocol, but from day 0 to day 7, the mean rate of decline of human chorionic gonadotropin was significantly more rapid with the single-dose versus the 2-dose protocol (mean change −31.3% versus −10.4%; P=.037). There were no significant differences in success rate or time to resolution for the 2 protocols.

“In a racially and geographically diverse group of women, the single- and double-dose methotrexate protocols had comparable outcomes,” the authors write. “The more rapid human chorionic gonadotropin initial decline in the single-dose group suggested these patients were probably at lower risk for ectopic rupture than those getting the 2-dose protocol.”


Mergenthal MC, et al. “Medical Management Of Ectopic Pregnancy With Single-Dose And 2-Dose Methotrexate Protocols: Human Chorionic Gonadotropin Trends And Patient Outcomes”. American Journal of Obstetrics and Gynecology. 2016. 215(5): 590.e1-590.e5. doi: 10.1016/j.ajog.2016.06.040.

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