Abstract

Methotrexate (MTX) is a medical treatment option for early pregnancy complications like ectopic pregnancy. We conducted a retrospective review of all women treated with systemic MTX in early pregnancy from January 2018 to December 2020 in Cork University Maternity Hospital. Reasons for treatment were tubal ectopic pregnancy (70%, n=51), persistent pregnancy of unknown location (22%, n=16) and caesarean scar pregnancy (7%, n=5). Treatment was successful in 88% (n=44) of tubal ectopic pregnancies, with 73% (n=37) of women receiving a single dose and 14% (n=7) receiving repeated doses. Only 8% (n=4) of tubal ectopic pregnancies required emergency surgery for subsequent tubal rupture. In 93% (n=15) of cases of persistent pregnancy of unknown location treatment was successful, with one woman requiring uterine evacuation. Women with caesarean scar pregnancy were treated with combined MTX and uterine evacuation without any issues. The effectiveness of medical treatment with systemic MTX for confirmed tubal ectopic pregnancy in our hospital is in line with national and international standards. Careful consideration should be given to treating caesarean scar pregnancy and persistent pregnancy of unknown location with systemic MTX. Systemic MTX use guided by doctors specialised in early pregnancy complications, and safe medication practices, may improve treatment success and reduce adverse events.