Retrospective review of the medical management of ectopic pregnancies with methotrexate at a South African tertiary hospital
Background.An ectopic pregnancy can be a life-threatening condition. Early diagnosis with ultrasonography and quantitative beta-human chorionic gonadotrophin (β-hCG) measurement has improved early and accurate diagnosis and treatment. Medical management with methotrexate internationally has a success rate of up to 93%, but there is a paucity of data on this treatment option in developing countries.
Objective. To determine the success of methotrexate treatment for ectopic pregnancies at a referral hospital in a developing country. This non-surgical, outpatient treatment seems a good option in hospitals with an ever-rising pressure on bed occupation and long waiting lists for emergency surgery.
Methods. A 5-year retrospective audit was performed on 124 patients treated for ectopic pregnancies with methotrexate at Tygerberg Hospital, Cape Town, South Africa.
Results. With success defined as a β-hCG level of <15 IU/L without requiring surgical intervention, the success rate was 44%. Fifteen per cent of medically managed patients required surgery. The remaining 41% were lost to follow-up. One patient had a major adverse outcome with a ruptured ectopic and required 2 units of blood, resuscitation and emergency laparotomy.Conclusion. Medical management of ectopic pregnancies is a safe and effective management option, as proven by international data, but at Tygerberg Hospital the safety of this treatment modality cannot be guaranteed because of poor follow-up. Improvement in patient selection with consideration of predictors of success and thorough counselling, as well as full informed consent, is recommended before using this treatment modality. A new follow-up system should be developed at Tygerberg Hospital to guarantee patient safety.
Liesl de Waard, Department of Obstetrics and Gynaecology, Tygerberg Hospital and Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa
J L Butt, Department of Obstetrics and Gynaecology, Tygerberg Hospital and Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa
C J B Muller, Department of Statistics and Actuarial Science, Stellenbosch University, Stellenbosch, South Africa
C A Cluver, Department of Obstetrics and Gynaecology, Tygerberg Hospital and Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa
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Date published: 2014-10-23
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