Approximately 2 percent of pregnanc...

Approximately 2 percent of pregnancies in this political division are ectopic, a condition that may cause significant hemorrhage and other serious complications. The succes rates of medical treatment are comparable to those of surgery with the added advantages of avoiding anesthetic and surgical risk while retaining fertility. couple protocols are currently used for medical treatment of ectopic pregnancy. "Single-dose" methotrexate therapy is given in a dosage of 50 mg by [m.sup.2] of body surface area. The "multidose" regimen consists of 1 mg for kg of methotrexate, alternating with 01 mg by kg of leucovorin, for up to four doses of each agent. one as well as the other regimens are effective but have not been compared directly in a clinical trial. Barnhart and colleagues compared evidence for the efficacy and tolerability of single-dose and multidose regimens of methotrexate in the treatment of ectopic pregnancy.

between the sides of electronic and manual searches, the authors identified 213 relevant articles, 26 of which met criteria for quality and inclusion in the analysis. They reviewed 1327 cases of women with ectopic pregnancy who had been treated with methotrexate. The overall succes rate of treatment was 89 percent with 36 percent of women reporting side results In the single-dose group, 145 percent of women required more than common dose of methotrexate. In the multidose form into groups 53.5 percent received four or more doses. The overall succes rate in the 1067 women treated with the single-dose regimen was 881 percent compared with 927 percent in the 260 women treated with the multidose regimen. Side consequences were reported by 31.3 percent of women receiving single-dose therapy and 412 percent of those receiving the multidose regimen. Rates of hospital admission were similar in the sum of two units groups (12.4 percent for single-dose therapy and 11 percent for multidose therapy).

The authors gather that although the multidose regimen of methotrexate is associated with significantly more side drifts and is more complicated to administer, it is more effective than the single-dose protocol for treatment of unruptur ectopic pregnancy. Because abortive medical treatment could result in hemorrhage, crisis surgery, or even death, the additional efficacy of multidose treatment outweighs the greater convenience and lower rate of side weights associated with single-dose treatment.

Barnhart KT et al. The medical management of ectopic pregnancy: a meta-analysis comparing "single dose" and "multidose" regimens. Obstet Gynecol April 2003;101: 778-84

ANNE D WALLING, MD

COPYRIGHT 2003 American Academy of Family Physicians

COPYRIGHT 2003 Gale Group