Medical management of ectopic pregnancy primarily involves the use of methotrexate (MTX), a drug that stops the growth of the ectopic pregnancy tissue. This approach is suitable for select cases based on specific criteria to ensure safety and effectiveness.
Indications for Medical Management of Ectopic Pregnancy:
- Unruptured Ectopic Pregnancy
The ectopic mass must be intact without signs of rupture or internal bleeding, making conservative management possible. - Stable Hemodynamics
The patient should be clinically stable with no signs of acute abdominal pain, significant bleeding, or shock. - Ectopic Mass Size Less Than 3.5 to 4 cm
Smaller ectopic masses respond better to medical management, and larger masses increase the risk of rupture. - Serum β-hCG Level Below 5000 mIU/mL
Lower β-hCG concentrations indicate early-stage ectopic pregnancies and predict better response to methotrexate. - No Fetal Cardiac Activity Detected on Ultrasound
Presence of fetal heart activity suggests a higher risk of treatment failure with MTX. - Patient Willingness and Ability for Follow-Up
Close monitoring of β-hCG levels and clinical condition is essential after medical treatment, so patients must commit to regular follow-up visits. - No Contraindications to Methotrexate
Methotrexate should be avoided in patients with hepatic, renal diseases, blood dyscrasias, immunodeficiency, or known hypersensitivity to the drug.
Summary of Criteria for Medical Management
- Unruptured ectopic pregnancy
- Hemodynamically stable patient
- Ectopic mass < 3.5-4 cm
- β-hCG < 5000 IU/mL (optimal <3000 IU/mL)
- No fetal cardiac activity
- No contraindications to methotrexate
- Reliable for follow-up
Conclusion
Medical management with methotrexate is a safe and effective first-line treatment option in carefully selected ectopic pregnancy cases. It avoids surgery and preserves fertility when criteria are met. However, surgery remains necessary for ruptured or complicated ectopic pregnancies, or when medical treatment fails.