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Medical management of ectopic pregnancy

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This document outlines the medical management of ectopic pregnancies. It describes the criteria for using medical management, including gestational sac size and beta HCG levels. The main drug used is methotrexate, which works by depleting folate cofactors and inhibiting trophoblast growth. Methotrexate can be given as a single intramuscular dose or multiple doses over days, monitoring beta HCG levels. Other drugs like potassium chloride, prostaglandins, and hyperosmolar glucose can also be locally injected under ultrasound guidance to terminate the ectopic pregnancy. Contraindications for methotrexate are also listed.

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Medical management of ectopic pregnancy
Criteria for medical management No hemodynamic instability No tubal rupture Fertility desired Gestational sac < 3.5cm Beta HCG level < 5000mIu/ml No cardiac motion on USG Ability and willingness to comply with follow up.
Drugs commonly used are: Methotrexate (drug of choice) Potassium chloride Prostaglandin(PGF留) Hyperosmolar glucose
Methotrexate mechanism of action & regimens MOA: methotrexate depletes tetrahydrofolate cofactors for DNA & RNA synthesis and inhibits rapidly growing trpohoblast of EP. Regimens: 1)Single dose- methotrexate i.m 50mg/m族 of body surface area. o 硫-HCG level on D and D is measured, minimum difference of > 15 percent should be there o Dose to be repeated - if difference is < 15 percent b/w D and D . OR o fetal cardiac activity is present on D. o 硫-HCG level is repeated weekly until undetectable. 2)Multiple dose- methotrexate 1mg/kg i.m on D,D,D,D & lecuovorin 0 .1mg/kg i.m on D,D,D,D o 硫-HCG level is measured every alternate day, Until decreased upto 15 percent in 2 consecutive days o Then weekly 硫-HCG level estimation is done until undetectable.
Contraindication of methotrexate Hemoperitoneum Breast feeding Immunodeficiency EP > 4cm Alcoholism Hepatic/Renal disease Blood disorder
Local injection 20 percent potassium chloride 0.5 ml under USG guidance causes asystole & resolution of ectopic Hyperosmolar glucose 1 to 3 ml injected into the sac. PGF留 when injected causes contraction and vasoconstriction thus resolution of pregnancy.
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Medical management of ectopic pregnancy

  • 1. Medical management of ectopic pregnancy
  • 2. Criteria for medical management No hemodynamic instability No tubal rupture Fertility desired Gestational sac < 3.5cm Beta HCG level < 5000mIu/ml No cardiac motion on USG Ability and willingness to comply with follow up.
  • 3. Drugs commonly used are: Methotrexate (drug of choice) Potassium chloride Prostaglandin(PGF留) Hyperosmolar glucose
  • 4. Methotrexate mechanism of action & regimens MOA: methotrexate depletes tetrahydrofolate cofactors for DNA & RNA synthesis and inhibits rapidly growing trpohoblast of EP. Regimens: 1)Single dose- methotrexate i.m 50mg/m族 of body surface area. o 硫-HCG level on D and D is measured, minimum difference of > 15 percent should be there o Dose to be repeated - if difference is < 15 percent b/w D and D . OR o fetal cardiac activity is present on D. o 硫-HCG level is repeated weekly until undetectable. 2)Multiple dose- methotrexate 1mg/kg i.m on D,D,D,D & lecuovorin 0 .1mg/kg i.m on D,D,D,D o 硫-HCG level is measured every alternate day, Until decreased upto 15 percent in 2 consecutive days o Then weekly 硫-HCG level estimation is done until undetectable.
  • 5. Contraindication of methotrexate Hemoperitoneum Breast feeding Immunodeficiency EP > 4cm Alcoholism Hepatic/Renal disease Blood disorder
  • 6. Local injection 20 percent potassium chloride 0.5 ml under USG guidance causes asystole & resolution of ectopic Hyperosmolar glucose 1 to 3 ml injected into the sac. PGF留 when injected causes contraction and vasoconstriction thus resolution of pregnancy.