Nonsurgical management of unruptured ectopic pregnancy: an extended clinical trial

Fertil Steril. 1987 Nov;48(5):752-5.


Unruptured tubal pregnancies diagnosed at laparoscopy were treated with either methotrexate/citrovorum factor (MTX/CF) (n = 21) or observation (n = 5). Entry criteria required that the ectopic pregnancy be visualized, less than or equal to 3 cm in diameter, with intact serosa and no active bleeding. Treatment selection was based upon preoperative levels of beta-human chorionic gonadotropin (beta-hCG), with MTX/CF given to subjects exhibiting a plateaued or rising pattern and observation alone given to those with falling levels. Twenty-five of 26 ectopic pregnancies resolved without need of laparotomy. Two subjects received blood transfusions and one required a second operation for intra-abdominal bleeding. In both cases, fetal cardiac activity was noted pretreatment on ultrasound. The authors conclude the following: (1) MTX/CF may be safely used to treat selected unruptured ectopic pregnancy; (2) many ectopic pregnancies resolve spontaneously; and (3) ectopic pregnancies that form fetal elements, as evidenced on ultrasound, should not be managed medically.

Publication types

  • Clinical Trial
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Chorionic Gonadotropin / blood
  • Chorionic Gonadotropin, beta Subunit, Human
  • Clinical Trials as Topic
  • Drug Therapy, Combination
  • Female
  • Humans
  • Leucovorin / therapeutic use
  • Methotrexate / adverse effects
  • Methotrexate / therapeutic use
  • Peptide Fragments / blood
  • Pregnancy
  • Pregnancy, Ectopic / blood
  • Pregnancy, Ectopic / drug therapy
  • Pregnancy, Ectopic / therapy*
  • Recurrence


  • Chorionic Gonadotropin
  • Chorionic Gonadotropin, beta Subunit, Human
  • Peptide Fragments
  • Leucovorin
  • Methotrexate