Methotrexate Use in Ectopic Pregnancy

Forums Interesting Cases Methotrexate Use in Ectopic Pregnancy

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  • #631 Reply

    Pharm For Life

    Hello,

    I came across a reference that reported in a majority of ectopic pregnancies a live embryo is not present. It then goes on to state that if based on ultrasound & bloodwork etc. it is determined embryonic death has occurred, methotrexate is a morally licit option. (Source: textbook by Catholic Medical Association – Catholic Witness in Health Care – Practicing Medicine in Truth & Love – 2017 pg 121-124 (preview available on google books))

    My question is; if the embryo is not alive, is there still risk tissue would continue to grow/expand increasing the risk of fallopian tube rupture? My initial thought was if there is embryonic death, what is the point of methotrexate since it targets rapidly dividing cells, but perhaps there could be the continued growth of trophoblast tissue?

    Thanks in advance! Sorry if this is an obvious question to my colleagues in medicine. In pharmacy school, we did not spend any time covering this topic. ( I have an opportunity to take a position in hospital pharmacy & I anticipate orders for methotrexate in such scenarios could be something I come across and I want to be prepared on how to handle this)

    #639 Reply

    Hello!

    This is a good question!

    You are right in your thinking that if the embryo is dead, that growth is unlikely. And a 1998 Lancet article showed that 68% of ectopics resolved with expectant management (no medical or surgical treatment). If beta-hCG is <200, then 88% resolved spontaneously.

    Still, the trophoblast can still grow even thought the embryo is not alive. The slow rise of the beta-hCG level in serum can demonstrate growth of trophoblastic tissue.

    In regards to forming your conscience, see the list of documents on our page here: https://conscienceinresidency.com/ectopic-pregnancy/

    If you do not have access to any of the articles you are interested in, please let us know and we can get them for you!

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