Medical treatment of ectopic pregnancy preserves reproductive potential

Editor—We agree with Mascarenhas et al that laparoscopic or medical treatment should now replace laparotomy in the treatment of ectopic pregnancy.1 We disagree, however, with the statement that methotrexate treatment does not seem to be a replacement for laparoscopic salpingotomy. The authors suggest that methotrexate injection may be associated with increased abdominal pain six to seven days after the treatment as well as a transient increase in human chorionic gonadotrophin titres within the first four days. They suggest that the increased titres may cause undue distress and lead to additional treatment.

It is true that 15-20% of patients experience abdominal pain six to seven days after methotrexate treatment, but this responds to mild pain relief. The rise in titres of human chorionic gonadotrophin up to day 4 is irrelevant as protocols for methotrexate treatment take into account the titres on days 4 and 7. If the titres between days 4 and 7 drop by ≥15% then a second injection …