Metotrexate in postoperative treatment in the patients after laparoscopic tubotomy

Abstract

Objective: The aim of the study was to assess the efficiency of METOTREXATE in postoperative treatment in the patients after laparoscopic tubotomy.

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Methods: Follow up of 66 patients, aged from 17 - 37, after laparoscopic tubotomy for progressive tubal pregnancy was done. The size of ovum was located in the distal part of the tube in 46 cases, in proximal - in 20. The size of ovum did. not exceed 4 cm in all cases. During of laparoscopy a longitudinal incision was made over the area of chorion localization, aqua dissection was performed, the incision was left open. Transvaginal echography was done every second day in combination with Color Doppler (CD) in 66 patients followed up in postoperative period. Chorionic Gonadotropin (CG) concentration was evaluated.

Results: 57 patients had normal regression of CG level, no pathology of the operated, lube was found by echography. Enlargement of the operated uterine tube caliber and color signals of trophoblastic blood flow in the site of tubotomy was found in 9 patients. CG indexes in blood remained stable or slightly decreased. Those patients were given methotrexate in the dose of 40 mg intramuscular once per day (6 out of 9 got 80 mg, 3 - 120 mg) under dynamic US-CD-CG-control every second day. All the patients which got methotrexate were noted to have a positive effect that allowed to avoid the removal of the uterine tube after tubotomy. There were no side effects in the use of cytostatic. Retrospective analysis of fertile function revealed the fact that during 4-5 years pregnancy occurred in all patients: uterine pregnancy in 8 cases, repeated ectopic pregnancy in one case (with the only uterine tube after tubotomy).

Conclusions: Thus the use of methotrexate allows to avoid the removal of the uterine tube after laparoscopic tubotomy in the patients with persistent tubal pregnancy.