Complications
Includes hepatotoxicity (direct damage to hepatocytes), nephrotoxicity (tubular injury from methotrexate crystal formation), myelosuppression (pancytopenia), and pulmonary toxicity.
May also cause gastrointestinal effects (nausea, vomiting), stomatitis, neurological problems (fatigue, headache), and fever.
The treatment for adverse reactions to methotrexate is immediate discontinuation.
The incidence of persistent ectopic pregnancy is reported to be 4% to 15%.[96] It is most commonly seen following a laparoscopic salpingostomy, but may also occur after medical and expectant management and rarely with salpingectomy.
A serum beta human chorionic gonadotropin (hCG) level should be measured 1 week after laparoscopic salpingostomy and if levels rise or plateau, this indicates a possible persistent trophoblast and can be treated with a single dose of intramuscular methotrexate (50 mg/m² of body surface area).[47][63] A repeat hCG level should be measured 1 week later and then weekly until undetectable.[63]
If medical management is not an option (e.g., history of adverse reaction to methotrexate), surgical intervention with either a laparoscopic or open approach may be used for definitive treatment.
This is a possible risk from any surgical intervention.
Possibilities include injury during laparoscopy trocar insertion or bleeding at the surgical site.
The sustained damage is repaired surgically by the surgeon or a specialist as necessary.
Rate is 8% to 15% with odds ratio of 9.3% to 47%.[2][26] The risk is related to the underlying factor that led to the initial ectopic pregnancy.
One retrospective review found the rates of recurrent ectopic pregnancy following single-dose methotrexate, salpingectomy, and linear salpingostomy to be 8%, 9.8%, and 15.4%, respectively.[26]
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