Single-Dose Systemic Methotrexate for the Treatment of Persistent Ectopic Pregnancy After Conservative Surgery

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To determine whether a single outpatient methotrexate injection successfully treats persistent ectopic pregnancy.


Nineteen consecutive patients with increasing β-hCG titers after conservative surgery for ectopic pregnancy were treated with a single intramuscular methotrexate (50 mg/m2) injection.


All 19 patients had resolution of their β-hCG titers without subsequent surgery. Beta-hCG levels commonly increased during the first 3 days after treatment, but subsequently declined. Two patients required hospital admission for observation and analgesia. One of these two patients had probable self-limited intra-abdominal bleeding and required a blood transfusion.


A single methotrexate injection is a safe and successful treatment for persistent ectopic pregnancy. Delayed hemorrhage may be a rare complication, and close surveillance is necessary.

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