METHOTREXATE OR EXPECTANT MANAGEMENT IN ECTOPIC PREGNANCY/PREGNANCY OF UNKNOWN LOCATION WITH LOW SERUM Β-HCG: A RANDOMIZED COMPARISON AT ALLIED HOSPITAL FAISALABAD

Abstract

Objective: The primary aim of this study was to compare the effectiveness and safety of systemic methotrexate (MTX) versus expectant management in women with ectopic pregnancy or pregnancy of unknown location (PUL) and low serum β-hCG levels. Background: Ectopic pregnancy occurs in approximately 1–2% of all pregnancies and remains a leading cause of maternal morbidity and mortality. With advancements in diagnostic tools such as transvaginal ultrasound and β-hCG monitoring, non-surgical management options, including MTX and expectant management, have become increasingly viable. This study aims to evaluate the efficacy and safety of these two management approaches in a local context. Methods: A randomized controlled trial was conducted at Allied Hospital Faisalabad, where 190 women were enrolled. Participants were randomly assigned to receive either systemic methotrexate (MTX) or expectant management. The study measured treatment success, the rate of surgical intervention, and complications, with β-hCG levels being closely monitored during the follow-up period. Results: Expectant management demonstrated a higher success rate in resolving ectopic pregnancies (93.7%) compared to methotrexate treatment (76.8%). The need for surgical intervention was significantly lower in the expectant management group (2.1%) compared to the MTX group (9.5%). Additionally, no major complications such as tubal rupture occurred in the expectant management group, whereas the MTX group had two cases requiring emergency surgery. Both groups exhibited similar time to resolution, with a mean of 16.9 days for expectant management and 17.6 days for methotrexate. Conclusion: Expectant management is a safe, effective, and less invasive alternative to methotrexate for the treatment of ectopic pregnancy and PUL in women with low serum β-hCG levels and stable clinical conditions. This study provides strong evidence supporting the use of expectant management as a first-line approach in carefully selected patients, potentially reducing unnecessary medication use and improving patient outcomes. Given its higher success rate and fewer complications, expectant management should be considered as an alternative to methotrexate in clinical practice. Implications for Practice: The results of this study suggest that expectant management should be incorporated as a first-line option for stable patients with low β-hCG levels and minimal symptoms. This patient-centered approach may improve outcomes by minimizing unnecessary interventions, reducing healthcare costs, and enhancing patient satisfaction.