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Risk of Methotrexate Failure for Ectopic Pregnancy

doi: 10.1097/01.EEM.0000553489.47425.6a
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Women diagnosed with ectopic pregnancy and treated with methotrexate in the ED found high rates of return ED visits. (CJEM 2018. doi: 10.1017/cem.2018.440.) Patients for whom methotrexate treatment failed had on average 1.7 return visits to the ED. Twenty-seven (17.8%) of the 152 patients treated with methotrexate went on to require surgical management, with 17 (11.2%) documented as having rupture.

Twenty (13.1%) patients had at least one relative contraindication to methotrexate (pretreatment bHCG levels of >5,000 mIU/mL, the presence of fetal cardiac activity, or an ectopic pregnancy size of >4 cm). Five of these patients (25%) had an ectopic rupture, and three (15%) required nonurgent surgical management.

This study was conducted in a Canadian academic tertiary care institution with a high-acuity obstetrics program, suggesting a high level of expertise with ectopic pregnancy. Just because your obstetrical consultant ordered the methotrexate for your ED patient does not mean that contraindications were properly evaluated.

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