Medical Management of Ectopic Pregnancy

Methotrexate is the standard medical management for ectopic pregnancy. Pharmacologically, it is a folic acid antagonist which inhibits DNA synthesis. 90% of appropriately selected un-ruptured none live ectopic pregnancy respond to methotrexate treatment with no further management is required. In the UK, NICE guidance has identified the selection criteria to achieve the best and safest outcome in ectopic pregnancy treatment with methotrexate. Methotrexate also has a role in management of pregnancy of unknown location. Single administration of 50 mg/m2 body surface area is the most widely acceptable regimen for methotrexate in treatment of ectopic pregnancy. Post treatment b-HCG checks at day 0, 4 and 7 are also a widely accepted follow up regimen to ensure satisfactory decline in b-HCG levels. Methotrexate has a role also in managing none tubal ectopic pregnancies where surgical risks are high. Post treatment transient pain is common and represent a clinical challenge as it can also be failed treatment with ruptured ectopic pregnancy.