Published: 2021-02-24

Medical management of ectopic pregnancy in a low resource setting: the role of methotrexate

Simon Birame Ndour, Mamour Gueye, Abdoul Aziz Diouf, Moussa Diallo


Background: Medical treatment using methotrexate. However, its indications and the protocol of administration are still under discussion. Even if follow-up problems are often raised in developing countries, medical treatment of ectopic pregnancy remains a reasonable option that we practice and share our experience here.

Methods: We performed a retrospective cohort study of patients managed for an unruptured ectopic pregnancy in two university hospital facilities in Dakar: the Centre Hospitalier National de Pikine and the Centre de Santé de Philipe Maguilen Senghor. The data of this study are spread over a period of 10 years, from 2010 and 2019. We planned to evaluate maternal age, parity, gestational age, diagnosis circumstances, medical management, monitoring, and outcome. A single dose protocol was used. Data extracted from the registries were transferred to Microsoft Excel 2019, Mac version and then moved to SPSS (Statistical Package for Social Sciences, 26.

Results: Over ten years, we had registered 18 patients who had received medical treatment out of a total of 263 ectopic pregnancies treated in the two facilities, i.e., a frequency of 6.8%. The average age was 28.8 years. The average initial HCG level was 10,460 mIU/ml. Treatment succeeded in more than 6 out of 10 patients (61.1%). However, we noted 5 cases of failure that had secondarily benefited from salpingectomy by laparotomy.

Conclusions: Methotrexate is now part of the therapeutic arsenal in the management of unruptured tubal ectopic pregnancies. However, in developing countries, particularly in Senegal, there is a reluctance to use this therapeutic method, which, however, when a personalized follow-up is carried out, is achievable with a success rate comparable to other therapeutic methods.


Dakar (Senegal), Ectopic pregnancy, Low resource, Methotrexate

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