A systematic review of single-dose intramuscular methotrexate for the treatment of ectopic pregnancy

Aust N Z J Obstet Gynaecol. 1998 May;38(2):145-50. doi: 10.1111/j.1479-828x.1998.tb02988.x.


The use of single-dose intramuscular methotrexate for the primary treatment of ectopic pregnancy is increasing in frequency in many countries. We performed a systematic review of all available studies and case reports of intramuscular methotrexate to examine the therapeutic efficacy, side-effects and complication rates of this new treatment approach. The pooled data show a successful resolution rate of 71% (95% confidence interval 58% to 81%) after a single dose of intramuscular methotrexate and 84% (95% confidence interval 77% to 90%) after 1 or 2 doses. Side-effects were experienced by 24% (95% confidence interval 9% to 47%) of patients and 10% (95% confidence interval 7% to 14%) had a ruptured ectopic pregnancy. The pooled data show that single-dose intramuscular methotrexate is associated with a high failure rate. Follow-up is prolonged and there is a significant incidence of minor side-effects. Serious complications and side-effects have occurred. The use of intramuscular methotrexate should be confined to clinical trials until more evidence is obtained to support its more widespread use.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Adult
  • Drug Administration Schedule
  • Female
  • Humans
  • Injections, Intramuscular
  • Methotrexate / administration & dosage*
  • Methotrexate / adverse effects
  • Pregnancy
  • Pregnancy, Ectopic / drug therapy*
  • Pregnancy, Ectopic / mortality
  • Pregnancy, Tubal / drug therapy
  • Pregnancy, Tubal / mortality
  • Risk Factors
  • Rupture, Spontaneous
  • Survival Analysis
  • Treatment Failure


  • Methotrexate