Clinical Outcome & Side Effect of Methotrexate in the Treatment of Unruptured Tubal Ectopic Pregnancy in a Tertiary Care Hospital

Open Access

Abstract

Background: Ectopic pregnancy is a major cause of maternal morbidity & mortality during early gestation. Methotrexate therapy offers a conservative, fertility-preserving alternative for unruptured tubal ectopic pregnancies; however, outcomes vary across populations. Objectives: This study aimed to evaluate the clinical outcomes and side effects of methotrexate in treating unruptured tubal ectopic pregnancy at a tertiary care hospital in Bangladesh. Methods & Materials: This prospective observational study was conducted at the Department of Obstetrics and Gynecology, Shaheed Suhrawardy Medical College and Hospital, Dhaka, Bangladesh, from July 2024 to June 2025. A total of 100 hemodynamically stable women diagnosed with unruptured tubal ectopic pregnancy were treated with intramuscular methotrexate (50 mg/m²). Serum β-hCG was monitored on days 4 and 7; success was defined as a ≥15% decline between these intervals and complete resolution without surgery. Data were analyzed using SPSS version 25.0. Results: The overall treatment success rate was 82%, with 72% of patients achieving resolution after a single dose and 10% requiring a second dose. Mean β-hCG resolution time was 31.6 ± 8.7 days. Significant predictors of success included baseline β-hCG levels <5000 mIU/mL (p = 0.02) and ectopic mass size <4.0 cm (p = 0.03). Adverse effects were mild, with abdominal pain (28%) and nausea/vomiting (22%) being the most common. Conclusion: Methotrexate is a highly effective, safe, and well-tolerated non-surgical option for appropriately selected patients with unruptured tubal ectopic pregnancy in tertiary care settings.